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Wu YS, Cheung YTD, Ho SY, Tong HSC, Lai VWY, Lam TH, Wang MP. Perception of heated tobacco products and support for regulations: a cross-sectional study in Hong Kong. Tob Control 2024; 33:e132-e135. [PMID: 36344255 DOI: 10.1136/tc-2022-057401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hong Kong has proposed banning the sale of heated tobacco products (HTPs). Perceptions of reduced harms and effectiveness for quitting combustible cigarettes (CCs) of HTPs due to their promotions may erode public support for regulations. We assessed the associations between perceptions of HTPs and support for regulations in Hong Kong. METHODS In two population-based landline surveys conducted in 2018-2019, 1985 respondents (51.4% male; 22.7% aged 60+ years) reported perceived relative harm of HTPs to CCs and effectiveness for quitting CCs, and support for five HTP regulations (ban on promotion and advertisements, use in smoke-free areas, sales to minors, registration before sale, sale licence) and a total ban on sale. Current and former smokers were oversampled due to low prevalence. Descriptive statistics were weighted to the general population. Associations were analysed, adjusting for sociodemographic characteristics, smoking status and ever HTP use. RESULTS 27.4% (N=515) of respondents perceived HTPs as less harmful, and 18.8% (N=1299) perceived them as effective for quitting CCs. Support was generally high (at least one regulation, 99.1%, N=1959; all five regulations, 66.8%, N=1114; total ban, 63.5%, N=946). Perceptions of reduced harm were associated with lower support for all five regulations (adjusted risk ratio 0.85, 0.75 to 0.96) and a total ban on sale (0.58, 0.51 to 0.66). Results were similar for perceptions of effectiveness for quitting. CONCLUSIONS Lower support for HTP regulations and a total ban on sale were associated with perceptions of reduced harm and effectiveness for quitting CCs of HTPs in Hong Kong.
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Affiliation(s)
| | | | - Sai Yin Ho
- School of Public Health, 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
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
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Al Rajeh AM, Mahmud I, Al Imam MH, Rahman MA, Al Shehri F, Alomayrin S, Alfazae N, Elmosaad YM, Alasqah I. E-Cigarette Use among Male Smokers in Al-Ahsa, Kingdom of Saudi Arabia: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 20:143. [PMID: 36612462 PMCID: PMC9819296 DOI: 10.3390/ijerph20010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
E-cigarette use is increasing globally. Recent evidence suggests that e-cigarettes contain harmful substances that could cause adverse health outcomes. This study investigated the prevalence and associated factors of e-cigarette use among male current smokers in Saudi Arabia. We conducted a cross-sectional survey of adult male current smokers in the Al-Ahsa province of Saudi Arabia. Data were collected using a structured questionnaire. We performed logistic regression analyses to investigate the factors associated with e-cigarette use among adult male current smokers. 325 current smokers participated in the study. A third of them (33.5%) were e-cigarette users. Almost all the study participants (97.0%) had heard about e-cigarettes. Participants who were occasional smokers (Odds Ratio (OR): 2.28; 95% Confidence Interval (CI): 1.17-4.41) and had good knowledge perception of e-cigarettes (OR 3.49; 95% CI: 2.07-5.90) had higher odds of using e-cigarettes when compared to regular smokers of conventional cigarettes and current smokers with poor knowledge perception of e-cigarettes, respectively. In contrast, private employees (OR: 0.25, 95% CI: 0.07-0.85), and business owners (OR: 0.09, 95% CI: 0.01-0.63) had lower odds of using e-cigarettes compared to unemployed individuals. Compared with non-e-cigarette users, the rate of conventional cigarette smoking per day was significantly lower among e-cigarette users. Use of e-cigarette (OR: 3.57, 95% CI: 2.14-5.98), believing that e-cigarette quitting is hard (OR: 2.02, 95% CI: 1.17-3.49) and trying to quit e-cigarettes (OR: 2.17, 95% CI: 1.1-4.25) were found to be significant predictors of good knowledge perception of e-cigarettes among the current smokers. The use and knowledge perception of e-cigarettes were higher among occasional conventional male cigarette smokers than regular male smokers in Al-Ahsa province. The use of e-cigarettes as smoking cessation aids should be examined further in the Saudi Arabian setting.
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Affiliation(s)
- Ahmed M. Al Rajeh
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Ilias Mahmud
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al-Bukairiyah 52741, Saudi Arabia
| | - Mahmudul Hassan Al Imam
- School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, QLD 4701, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, QLD 4701, Australia
| | - Muhammad Aziz Rahman
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC 3350, Australia
- Australian Institute for Primary Care & Ageing (AIPCA), La Trobe University, Melbourne, VIC 3086, Australia
| | - Fariss Al Shehri
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Salman Alomayrin
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Nawaf Alfazae
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Yousif Mohammed Elmosaad
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Ibrahim Alasqah
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al-Bukairiyah 52741, Saudi Arabia
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Chau SL, Wang MP, Wu Y, Cheung DYT, Kong A, Lai V, Lam TH, Ho SY. Polytobacco product use among current cigarette smokers in Hong Kong, China: results from population surveys (2015-17). BMC Public Health 2021; 21:307. [PMID: 33549071 PMCID: PMC7866759 DOI: 10.1186/s12889-021-10341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Polytobacco product use is increasingly popular, but little is known about the prevalence, trend, and factors of such use particularly in non-western countries. METHOD A representative sample of 1139 current cigarette smokers aged 15+ (84.1% male) were telephone interviewed in Tobacco Control Policy-related Surveys in 2015-2017. Information collected included poly-tobacco use (PTU), smoking and socio-demographic characteristics. Associations of current PTU with related factors were analyzed using logistic regression with adjustment for confounders. Prevalence was weighted by age and sex of current cigarette users in the general population. RESULTS Eighty-four point one percent (95% CI 81.4-86.6%) were exclusive cigarette smokers. Fifteen point nine percent (13.4-18.6%) were current polytobacco product users, 12.3% (10.2-14.8%) used one tobacco product and 2.52% (1.59-3.97%) used two tobacco products in addition to cigarette. Cigarette use with cigar was more common (6.28%, 4.75-8.27%), and the least used product with cigarette was e-cigarette (1.05%, 0.44-2.50%). The changes in overall prevalence of PTU by number of products use varied in 3 years. Current PTU was associated with being male (AOR 2.01, 95% CI 1.12-3.61), younger age (AORs range from 1.34-4.65, P for trend < .001) and less ready to quit (2.08, 1.09-3.97). CONCLUSIONS Prevalence of PTU increased slowly by year, one tobacco product use with cigarette was more common. The most used tobacco product with cigarette was cigar. Being male, younger and less ready to quit were associated with current PTU.
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Affiliation(s)
- S L Chau
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - M P Wang
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
| | - Y Wu
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - D Y T Cheung
- School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - A Kong
- Hong Kong Council on Smoking and Health, 183 Queen's Road East, Wanchai, Hong Kong
| | - V Lai
- Hong Kong Council on Smoking and Health, 183 Queen's Road East, Wanchai, Hong Kong
| | - T H Lam
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong
| | - S Y Ho
- School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong
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Chung-Hall J, Fong GT, Meng G, Craig LV, McNeill A, Hitchman SC, Fernández E, Mons U, Trofor AC, Przewoźniak K, Zatoński WA, Demjén T, Katsaounou PA, Kyriakos CN, Vardavas CI. Support for e-cigarette policies among smokers in seven European countries: longitudinal findings from the 2016-18 EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii68-iii77. [PMID: 32918824 DOI: 10.1093/eurpub/ckaa085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The 2016 European Tobacco Products Directive (TPD) required Member States (MS) to implement new regulations for electronic cigarettes (ECs). We conducted a longitudinal study to assess changes over 2 years in smokers' support for EC policies and identify predictors of support in seven European countries after TPD implementation. METHODS Prospective cohort surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, Spain and England in 2016 (n = 9547; just after TPD) and 2018 (n = 10 287; 2 years after TPD). Multivariable logistic regression models employing generalized estimating equations assessed changes in support for four EC policies, and tested for country differences and strength of key predictors of support. RESULTS Banning EC use in smoke-free places was supported by 53.1% in 2016 and 54.6% in 2018 with a significant increase in Greece (51.7-66.0%) and a decrease in Spain (60.1-48.6%). Restricting EC/e-liquid nicotine content was supported by 52.2 and 47.4% in 2016 and 2018, respectively, with a significant decrease in England (54.2-46.5%) and Romania (52.5-41.0%). An EC promotion ban was supported by 41.1 and 40.2%. A flavour ban was supported by 33.3% and 32.3% with a significant increase in Hungary (34.3-43.3%). Support was generally higher in Poland, Hungary and Greece vs. England. Support was lower among dual and EC-only users, and low-income smokers. CONCLUSIONS Smokers in all countries strongly supported banning EC use in smoke-free places and restricting nicotine content after TPD implementation, with no clear trends for changes in policy support.
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Affiliation(s)
- Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine V Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Ann McNeill
- Department of Addictions, King's College London, London, UK
| | | | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.,Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.,School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Lasi, Romania.,Aer Pur Romania, Bucharest, Romania
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland.,Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Collegium Civitas, Warsaw, Poland
| | - Witold A Zatoński
- Health Promotion Foundation, Warsaw, Poland.,European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Paraskevi A Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece.,Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
| | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,School of Medicine, University of Crete, Heraklion, Greece
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Leung KM, Orekoya F, Bailey AJ, Lai HY, Chan KY, Lam TL. Health of Youth in Transition in Hong Kong. Int J Environ Res Public Health 2020; 17:ijerph17113791. [PMID: 32471062 PMCID: PMC7312970 DOI: 10.3390/ijerph17113791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 11/19/2022]
Abstract
This study aimed to examine the impact of individual (level of vigorous physical activity (VPA) and frequency of using sports and recreation facilities), interpersonal (perceived social cohesion (PSC)), and neighborhood environmental (availability of sports and recreation facilities) factors on youths’ health in transition in Hong Kong. A sample of 508 individuals aged 17–23 years from all Hong Kong council districts randomly completed validated questionnaires by telephone survey. Of 508,302 individuals with complete data pertaining to address geocoding were selected for further analyses. Overall, more than half of them (56.3%) used sports and recreation facilities once per month or less. Structural equation modeling was used to examine the relationship among the studies’ constructs. The results indicated that the proposed model sufficiently fitted the data (χ2 (24) = 32.23, p < 0.12; CFI = 0.977; SRMR = 0.051; RMSEA = 0.034 (90% CI = 0.000 to 0.061). However, two items of PSC were sequentially removed due to their low standardized factor loadings (<0.3). A structural model was reinserted into data analyses, and the modified model fitted the data well as indicated by fit indices (χ2 (11) = 15.29, p < 0.17; CFI = 0.987; SRMR = 0.054; RMSEA = 0.036 (90% CI = 0.000 to 0.075). Only VPA (β = 0.27, p = 0.0005) and PSC (β = 0.12, p = 0.048) were significantly related to perceived health at an individual level. To promote youth health, the Hong Kong government may work with the business sector, community groups, or education institutions to develop community programs to keep youths active (especially VPA) and to build more cohesive, trustful relationships among youths in the neighborhood.
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Affiliation(s)
- Ka-Man Leung
- Department of Health and Physical Education, University of Hong Kong, Hong Kong, China
- Correspondence: ; Tel.: +852-2948-8470
| | - Folake Orekoya
- Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong, China;
| | - Adrian J. Bailey
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, China;
| | - Hor-Yan Lai
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China;
| | - Ka-Yi Chan
- Centre for the Advancement of Social Sciences, Hong Kong Baptist University, Hong Kong, China; (K.-Y.C.); (T.-L.L.)
| | - Ting-Lok Lam
- Centre for the Advancement of Social Sciences, Hong Kong Baptist University, Hong Kong, China; (K.-Y.C.); (T.-L.L.)
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Kastaun S, Kotz D. [Should advertising for electronic cigarettes and heated tobacco products be banned in Germany? Results of a representative survey (DEBRA study)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1391-1396. [PMID: 31523755 DOI: 10.1007/s00103-019-03017-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The German federal parliament is discussing the implementation of a comprehensive tobacco advertising ban and whether that ban should include alternative nicotine delivery systems (ANDSs), such as e‑cigarettes and tobacco heaters. It would be important to know which outcome the general population, and in particular the users of tobacco/ANDSs, would prefer. OBJECTIVE Assessing public support for a comprehensive advertising ban on ANDSs in the German population, and particularly in tobacco and ANDSs users. MATERIAL AND METHODS The German Study on Tobacco Use ("Deutsche Befragung zum Rauchverhalten", DEBRA) is an ongoing, representative household survey of persons aged 14 years and older. Data from the June/July 2019 survey wave (n = 2019) were analysed. Participants were interviewed regarding their tobacco smoking status and ANDS use, sociodemographic factors, and their support of an advertising ban on ANDSs. Prevalence rates and associations (odds ratio, OR) between support and sociodemographic factors or use of tobacco/ANDSs are reported. RESULTS Of the population, 57.0% (95% confidence interval (95%CI) = 54.7-59.1%) support a ban on ANDS advertising; 11.1% (95%CI = 9.8-12.6%) reject it. There is support for the ban from 46.0% (95%CI = 42.2-49.9%) of current tobacco smokers and 42.7% (95%CI = 35.9-49.6%) of ANDS users. Ex-smokers show the highest rates of support (64.8%, 95%CI = 58.9-70.3%). Acceptance among never- and ex-smokers is higher than among current smokers (adjusted OR 2.06, 95%CI = 1.64-2.59 and OR 1.65, 95%CI = 1.23-2.21). CONCLUSIONS The majority of the German population supports a comprehensive advertising ban on ANDSs. Tobacco smokers and ANDS users are also more in favour of than against such a ban. Thus, only little resistance will be expected within the population if a comprehensive tobacco advertising ban, as currently discussed in parliament, includes e‑cigarettes and heated tobacco products.
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Affiliation(s)
- Sabrina Kastaun
- Institut für Allgemeinmedizin, Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Postfach 101007, 40001, Düsseldorf, Deutschland.
| | - Daniel Kotz
- Institut für Allgemeinmedizin, Schwerpunkt Suchtforschung und klinische Epidemiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Postfach 101007, 40001, Düsseldorf, Deutschland
- Department of Behavioural Science and Health, University College London, London, Großbritannien
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Zhu J, Shi F, Xu G, Li N, Li J, He Y, Yu J. Conventional Cigarette and E-Cigarette Smoking among School Personnel in Shanghai, China: Prevalence and Determinants. Int J Environ Res Public Health 2019; 16:ijerph16173197. [PMID: 31480564 PMCID: PMC6747063 DOI: 10.3390/ijerph16173197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 12/25/2022]
Abstract
Smoking cigarettes and e-cigarettes is widely popular among Chinese students. Considering that school personnel are considered role models in the student community, we investigated the prevalence and determinants of such behavior among high school personnel in China so as to provide references for future related intervention measures. We used a stratified cluster sampling design on a total number of 3311 school employees recruited from 33 representative schools. Complex sampling analysis and logistic regressions were used for univariate and multivariate analyses. Among 3194 participants that met the study criteria, 7.4% were cigarette users, and 3.6% e-cigarette consumers. For conventional cigarette smokers, certain characteristics, such as being older and male, attaining less education, and having been exposed to secondhand smoke, were associated with heavier smoking. Nevertheless, e-cigarette users were predominantly male and of younger age. Those who understood the hazards of conventional cigarette smoking had less inclination to smoke but were at a higher risk of e-cigarette use. Our analysis suggests that it is necessary to target different populations for monitoring and controlling conventional cigarette smoking and e-cigarette use respectively among school personnel. In addition, China is in need of more relevant and strict anti-smoking regulations.
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Affiliation(s)
- Jingfen Zhu
- School of Public Health, Fudan University, 130 Dongan Road, Shanghai 200032, China
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai 200025, China
| | - Fanghui Shi
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai 200025, China
| | - Gang Xu
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai 200025, China
| | - Na Li
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai 200025, China
| | - Jiahui Li
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai 200025, China
| | - Yaping He
- School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai 200025, China.
| | - Jinming Yu
- School of Public Health, Fudan University, 130 Dongan Road, Shanghai 200032, China.
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8
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Wu YS, Wang MP, Ho SY, Cheung YT, Kwong A, Lai V, Lam TH. Positive perceptions of electronic cigarettes relative to combustible cigarettes are associated with weaker support for endgame policies on combustible cigarettes: A population-based cross-sectional study in Hong Kong. Tob Induc Dis 2019; 17:61. [PMID: 31582950 PMCID: PMC6770616 DOI: 10.18332/tid/110697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/08/2019] [Accepted: 07/13/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Positive perceptions of electronic cigarettes (e-cigarettes) relative to combustible cigarettes (CCs) may erode support for endgame policies on CCs through smoking renormalization (increasing public acceptance of smoking). We investigated the associations between perceptions of e-cigarettes relative to CCs and support for endgame policies on CCs in Hong Kong. METHODS Adult respondents (N=2004) were surveyed using landline random digit dialing in 2015. Perceived relative harm and relative addictiveness of e-cigarettes were combined as an overall perception of e-cigarettes relative to CCs with 5 levels and we analyzed individually 'neutral/positive/mixed/unknown' perceptions against the 'negative' perception. Five individual items with dichotomous responses assessed the support for endgame policies on CCs. Support for banning the sale/use of CCs (yes/no) was also assessed. Multivariable regressions yielded adjusted odds ratios (AORs) of supporting endgame policies (individual policy items, all 5 policy items, at least 1 policy item, banning the sale/use of CCs) in relation to perceptions of e-cigarettes relative to CCs, adjusting for age, education attainment, marital status, CC smoking status and ever e-cigarette use. RESULTS Support for individual endgame policy items (from 51.8% to 80.0%), banning the sale (63.8%) and use (67.5%) of CCs were generally high. Few respondents perceived e-cigarettes as more harmful (16.6%) or more addictive (9.3%) than CCs. Positive perceptions of e-cigarettes (24.0%) were associated with less support for 'ban CC sales in 10 years if there is a product providing nicotine not made from tobacco' (AOR=0.62, 95% CI: 0.40-0.97), 'ban CC use when it's prevalence falls below 5%' (AOR=0.66, 95% CI: 0.44-0.98) and 'banning the sale of CCs' (AOR=0.63, 95% CI: 0.42-0.94). CONCLUSIONS Positive perceptions of e-cigarettes relative to CCs were associated with less support for endgame policies on CCs in Hong Kong. Public health actions are needed to disseminate evidence-based knowledge of e-cigarettes.
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Affiliation(s)
- Yongda S. Wu
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Yee Tak Cheung
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | - Antonio Kwong
- Hong Kong Council on Smoking and Health, Wan Chai, Hong Kong
| | - Vienna Lai
- Hong Kong Council on Smoking and Health, Wan Chai, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
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9
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Jiang N, Cleland CM, Wang MP, Kwong A, Lai V, Lam TH. Perceptions and use of e-cigarettes among young adults in Hong Kong. BMC Public Health 2019; 19:1123. [PMID: 31420031 DOI: 10.1186/s12889-019-7464-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background Little is known about the risk and addiction perceptions of e-cigarettes among Asian populations. We examined e-cigarette perceptions among young adults in Hong Kong and the association between the perceptions and e-cigarette use patterns. Methods An online survey was administered to a convenience sample of Hong Kong residents aged 18–35 (N = 1186). Measures of e-cigarette perceptions included perceived harm and addictiveness of e-cigarettes, perceived harm of secondhand e-cigarette aerosol, and perceived popularity of e-cigarette use among peers. Separate multinomial logistic regression models were conducted to examine the associations between the four perceptions and former and current use of e-cigarettes relative to never use, controlling for demographics and current cigarette smoking status. Interactions of e-cigarette perceptions and current cigarette smoking were assessed in all models. Among current e-cigarette users, bivariate exact logistic regression models were used to examine the relationships between each of the perceptions and frequent e-cigarette use (≥3 days in past 30-day vs. 1–2 days). Among participants who had never used e-cigarettes, separate multivariable logistic regression models were conducted to examine the associations between e-cigarette perceptions and susceptibility to e-cigarette use. Results Overall, 97.2% of participants were aware of e-cigarettes, and 16.1% had tried e-cigarettes (11.3% former users; 4.8% current users). Young adults perceived e-cigarettes (and aerosol) as less harmful, less addictive, and less popular than cigarettes. Current cigarette smokers reported significantly lower perceived harmfulness and addictiveness of e-cigarettes, lower perceived harmfulness of e-cigarette aerosol, and higher perceived popularity than nonsmokers. The lower degree of harm and addiction perceptions, and higher levels of popularity perceptions were associated with greater odds of e-cigarette use, and these relationships were generally stronger among nonsmokers compared to current cigarette smokers. E-cigarette perceptions were not associated with frequent e-cigarette use. Perceiving e-cigarettes (and aerosol) as less harmful and less addictive were associated with greater susceptibility to e-cigarette use. Compared to nonsmokers, current smokers were more likely to report e-cigarette use and susceptibility. Conclusions Continued monitoring of e-cigarette use and perceptions is needed. Educational programs should emphasize the potential harmful and addictive properties of e-cigarettes and the risks of secondhand exposure to e-cigarette aerosol. Electronic supplementary material The online version of this article (10.1186/s12889-019-7464-z) contains supplementary material, which is available to authorized users.
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Cheung YTD, Weng X, Wang MP, Ho SY, Kwong ACS, Lai VWY, Lam TH. Effect of prepaid and promised financial incentive on follow-up survey response in cigarette smokers: a randomized controlled trial. BMC Med Res Methodol 2019; 19:138. [PMID: 31272393 PMCID: PMC6610937 DOI: 10.1186/s12874-019-0786-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monetary incentive is often used to increase response rate in smokers' survey, but such effect of prepaid and promised incentives in a follow-up survey is unknown. We compared the effect of different incentive schemes on the consent and retention rates in a follow-up survey of adult cigarette smokers. METHODS This was a randomized controlled trial (RCT) in Hong Kong, China. Smokers who completed a non-incentivized baseline telephone smoking survey were invited to a 3-month follow-up, with randomization into (1) the control group (no incentive), (2) a promised HK$100 (US$12.8) incentive upon completion, (3) a promised HK$200 (US$25.6) incentive upon completion, or (4) a prepaid HK$100 incentive plus another promised HK$100 incentive ("mixed incentive"). Crude risk ratios from log-binomial regression models were used to assess if the 3 incentive schemes predicted higher rates of consent at baseline or retention at 3-month than no incentive. RESULTS In total, 1246 smokers were enrolled. The overall consent and retention rates were 37.1 and 23.0%, respectively. Both rates generally increased with the incentive amount and offer of prepaid incentive. The mixed incentive scheme marginally increased the retention rate versus no incentive (26.8% vs 20.3%; risk ratio (RR) = 1.32; 95% CI: 1.00-1.76; P = 0.053), but not the consent rate (RR = 1.13; 95% CI: 0.93-1.38; P = 0.22). Among the consented participants, approximately 50% in the mixed incentive group received the mailed prepaid incentive, who achieved a higher retention rate than the group without incentives (82.8% vs 56.1%; RR = 1.48; 95% CI: 1.21-1.80; P < 0.01). CONCLUSION The mixed incentive scheme combining the prepaid and promised incentive was effective to increase the follow-up retention rate by 48%. We recommend this mixed incentive scheme to increase the follow-up retention rate. More efficient methods of delivering the incentive are needed to maximize its effects. TRIAL REGISTRATION U.S. Clinical Trials registry (clinicaltrials.gov, retrospectively registered, reference number: NCT03297866 ).
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Affiliation(s)
| | - Xue Weng
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China.
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Wang W, He Z, Feng N, Cai Y. Electronic cigarette use in China: Awareness, prevalence and regulation. Tob Induc Dis 2019; 17:30. [PMID: 31516473 PMCID: PMC6662798 DOI: 10.18332/tid/105393] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/15/2019] [Accepted: 03/06/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION E-cigarettes were invented in China, and most of the world’s e-cigarettes have been produced in China. However, awareness and use of e-cigarettes in China are lower than in Europe and America. Against the backdrop of the increasing use of e-cigarettes, the supervision of e-cigarettes in China has been almost non-existent. METHODS A literature search was carried out in five popular Chinese and English databases. These databases were PubMed, EMBASE, the Cochrane Library, China national knowledge infrastructure (CNKI), and Wan-fang database. RESULTS Twenty-one studies were identified, and a comprehensive analysis of e-cigarette awareness ratio was conducted for different regions of China and according to gender, age group, and smoking status. We also examined e-cigarette use and associated risk factors, and the relationship between e-cigarette use and smoking cessation. In 2015, the prevalence of ‘ever use’ and ‘current use’ of e-cigarettes in China were 3.1% and 0.5%, respectively. The review indicates that the awareness ratio of e-cigarettes was about 66% in Hong Kong, whereas the ratio for Tianjin was lower (43.6%). Online sales were the main channel for selling e-cigarettes to 80% of the users. Awareness of e-cigarettes has been increasing in China. Awareness was higher in men compared to women in all age groups. Nevertheless, e-cigarette use in China was lower than in developed countries. E-cigarette users were more likely to try to quit smoking, but the relationship between e-cigarette use and smoking cessation is still unclear. Governance is necessary for e-cigarette use and marketing effort. CONCLUSIONS This study investigated the awareness and use of e-cigarettes in China and the existing regulations for e-cigarette use and marketing. The lack of regulations for e-cigarette use and the unrestricted practice encourage the increase in adoption of e-cigarettes and misconceptions of the benefits of using e-cigarettes. Hence, it is crucial that the government of China prioritize the establishment and implementation of regulations for e-cigarette use and marketing.
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Affiliation(s)
- Wenyuanyue Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - ZiAn He
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nannan Feng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyang Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
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Kilibarda B, Krstev S, Milovanovic M, Foley K. E-cigarette use in Serbia: Prevalence, reasons for trying and perceptions. Addict Behav 2019; 91:61-67. [PMID: 30473245 DOI: 10.1016/j.addbeh.2018.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Biljana Kilibarda
- Institute of Public Health of Serbia, Office for Smoking Prevention, Dr Subotica 5, 11 000 Belgrade, Serbia.
| | - Srmena Krstev
- Association "Health Mission", Krunska 6a, 11000 Belgrade, Serbia
| | - Minja Milovanovic
- University of the Witwatersrand, Perinatal HIV Research Unit, Soweto, South Africa
| | - K Foley
- Wake Forest School of Medicine, Department of Social Sciences and Health Policy, Medical Center Boulevard, Winston-Salem, NC 27157, United States
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Cheung YTD, Ho SY, Wang MP, Kwong A, Lai V, Lam TH. Pro-smoking responses and attitudes due to point-of-sale tobacco displays in never smokers: A cross-sectional study in Hong Kong. Tob Induc Dis 2018; 16:32. [PMID: 31516431 PMCID: PMC6659512 DOI: 10.18332/tid/92585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Never smokers' responses to tobacco control policy are often overshadowed by the opposition from smokers and tobacco industry during policy advocacy and legislation. Very few studies have examined never smokers' exposure to point-of-sale (POS) tobacco displays and their effects. Therefore, we investigated the exposure, pro-smoking responses due to and attitudes towards such displays in never smokers in Hong Kong. METHODS We conducted two-stage, randomized cross-sectional telephone-based surveys in 2015 and 2016 of 1833 never-smoking adults. They were asked how often they noticed POS displays in the past 30 days (often, sometimes, never), whether they found POS displays attractive, felt encouraged to smoke, perceived POS displays as advertisements, and if they supported banning them. The distributions of the outcomes were analyzed by descriptive statistics with weighting to the general population. Risk ratios (RR) from Poisson regression models adjusted for sociodemographic characteristics were used to analyze the associations. RESULTS Our results showed that, in never smokers, the younger were more likely to often notice POS displays (RR=0.80, 95% CI: 0.72-0.89, p<0.01). Finding POS displays attractive was associated with primary (RR=2.52, 95% CI: 1.51-4.22, p<0.01) and secondary education (RR=1.68, 95% CI: 1.16- 2.44, p=0.01) versus tertiary education. Often noticing displays was associated with perceived attractiveness (RR=1.90, 95% CI: 1.32-2.75, p<0.01). The positive association between often noticing displays and being encouraged to smoke was marginally significant (RR=4.05, 95% CI: 0.98-16.85, p=0.054). Respondents who often noticed POS displays (RR=0.87, 95% CI: 0.77-0.98, p=0.02) and did not perceive them as advertisements (RR=0.70, 95% CI: 0.61-0.98, p<0.01) showed less support on banning them than those who did not notice them. CONCLUSIONS Frequent exposure to POS displays was associated with greater perceived attractiveness and lower support for banning them. A total ban on POS displays is needed to eliminate the advertising and normalization effect of POS displays.
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Affiliation(s)
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Antonio Kwong
- The Hong Kong Council on Smoking and Health, Hong Kong, China
| | - Vienna Lai
- The Hong Kong Council on Smoking and Health, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Wu SYD, Wang MP, Li WH, Kwong AC, Lai VW, Lam TH. Does Electronic Cigarette Use Predict Abstinence from Conventional Cigarettes among Smokers in Hong Kong? Int J Environ Res Public Health 2018; 15:E400. [PMID: 29495388 PMCID: PMC5876945 DOI: 10.3390/ijerph15030400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/21/2018] [Accepted: 02/21/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate the effects of ever use of electronic cigarettes (ECs), many of which lack nicotine, on abstinence from convention cigarettes among Hong Kong adult smokers. METHODS We collected data from 956 daily smokers in 2014-2015 regarding ever EC use and smoking behaviors at baseline, any and past 30-day EC use at the 3-month follow-up. Outcomes measured at 6 months included past 7-day point prevalence abstinence (PPA), biochemically validated quitting, smoking reduction (≥50% from baseline) and cessation attempt. Logistic regression yielded adjusted odds ratios (AOR) for quitting in relation to EC use, adjusting for socio-demographic characteristics and smoking profile. Complete case, missing observation as smoking and propensity score analyses were conducted. RESULTS By complete case, ever EC use at baseline did not predict self-reported PPA (AOR 0.99, 95% CI 0.57-1.73), biochemically validated quitting (AOR 1.22, 95% CI 0.64-2.34), cessation attempt (AOR 0.74, 95% CI 0.48-1.14), or smoking reduction (AOR 0.89, 95% CI 0.54-1.47). EC use during the first 3 months did not predict quitting (AOR 1.02, 95% CI 0.22-4.71). Similar results were observed for missing observations as smoking and propensity score analyses. CONCLUSIONS Any use of ECs, many of which lack nicotine, did not predict smoking abstinence among Hong Kong adult smokers.
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Affiliation(s)
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China.
| | - William H Li
- School of Nursing, University of Hong Kong, Hong Kong, China.
| | | | - Vienna W Lai
- Hong Kong Council on Smoking and Health, Hong Kong, China.
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China.
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