Public support for e-cigarette regulation and its correlates in Hong Kong: a population-based cross-sectional study

Abstract

BACKGROUND: E-cigarette regulation has been proposed to reduce the harms of e-cigarettes in youth and non-e-cigarette users. Public support is needed for successful legislation. We found no population-based studies on public support towards e-cigarette regulation in Asian countries. This study aimed to gauge the Hong Kong general public’s support towards e-cigarette regulation, and identified factors associated with the support. METHODS: A telephone survey on 5,252 randomly selected Hong Kong residents (1,706 current smokers, 1,712 ex-smokers and 1,834 never-smokers) was conducted in 2015 to enquire if they supported banning of e-cigarette promotion and advertisement, banning its use in smoke-free venues, banning the sales to people aged under 18, and restricting the sales of nicotine-free e-cigarettes. Prevalence ratio (PR) was used to examine the factors associated with the support. Data were weighted by sex, age group, and smoking status of the general population. RESULTS: A great majority of respondents supported banning of e-cigarette use in smoke-free areas (81.5%, 95% CI 79.8%- 83.1%), banning of e-cigarette sales to minors (93.9%, 95% CI 92.7%-94.8%), and sales restriction of nicotine-free e-cigarettes (80.9%, 79.2%-82.5%), but the support for banning of e-cigarette promotion and advertisement (71.7%, 95% CI 69.7%-73.6%) was slightly lower. Being a current smoker was associated with a lower level of support (PR ranged from 0.77 to 0.96, p<0.01, reference group: never smokers), while perceiving e-cigarettes are as harmful as (PR ranged from 1.08 to 1.34, p<0.01, reference group: don’t know) or more harmful than conventional cigarettes (PR ranged from 1.07 to 1.41, p<0.01, reference group: don’t know) was associated with a greater level of support. CONCLUSIONS: The Hong Kong general public favored imposing legislative measures on e-cigarette sales, marketing and use in smoke-free areas. To increase the public support for e-cigarette regulation, we recommend more advocacy on the regulation through the mass media, conveying the adverse impact of e-cigarette marketing towards youth and the potential health hazard of e-cigarettes.