Support for plain cigarette packaging and its relation with reactions to current graphic health warning: a population-based cross-sectional study

Abstract

BACKGROUND: Large graphic health warning (GHW) and plain packaging (PP) can effectively warn about the risk of smoking and reduce smoking. To counteract tobacco industry opposition against the PP legislation, governments need strong public support. However, such support has not been gauged in Asia and little is known about its associated factors elsewhere. We gauged the support for PP in Hong Kong, and explore how it varied with different reactions to the current GHW (covering 50% of the packaging) in Hong Kong. METHODS: We included 2,337 respondents (932 never smokers, 844 ex-smokers and 561 current smokers) from a two-stage random sampling telephone survey in 2015 in the analysis. Four reactions to the current GHW in the past 30 days including (i) noticing (all respondents), (ii) thinking of harms of smoking (all respondents), (iii) thinking of quitting (ex- and current smokers) and (vi) forgoing cigarettes (current smokers) were enquired. Also, all respondents were briefly introduced about PP, and asked if they supported it. In each smoking status, prevalence ratio (PR) was used to examine the association of support for PP with reactions to GHW and other factors in each group of smoking status. RESULTS: Over three-quarters of non-smokers (79.7% of never smokers, 76.4% of ex-smokers) and about half (50.7%) of current smokers supported PP. Socio-demographic factors, noticing current GHW and thinking of smoking harms due to GHW were not significantly associated with the support in never smokers. In ex-smokers, only thinking of quitting (PR=1.12, 95% CI 1.02-1.22) was associated with more support. In current smokers, adjusted for all covariates, thinking of smoking harms (PR=1.26, 95% CI 1.05-1.51), thinking of quitting (PR=1.31, 95% CI 1.08-1.59) and forgoing cigarettes due to GHW (PR=1.45, 95% CI 1.16-1.81) were associated with greater support for PP. CONCLUSIONS: Public support for PP is strong in Hong Kong, supporting the advocacy and legislation of PP. Thinking of smoking harms and quitting, and forgoing cigarettes due to current GHW were associated with greater support for PP in current smokers, which suggest that strengthening current GHW could increase smokers’ support for PP.