Impact of the smoke-free legislation on youth quitting-related behaviors in Hong Kong via a smoking cessation hotline

Abstract

INTRODUCTION: The Hong Kong Government has implemented a comprehensive smoke-free legislation on 1 Jan 2007. Youth smoking is of concern as most adult smokers started smoking when they were young with long-term smoking behaviors resistant to cessation attempts. Western studies showed that youth smokers, particularly the boys, were more deterred by indoor smoking restrictions, and there was an association between restrictions on smoking in public places on youth smoking prevalence. However, few studies examined the impact on youth smokers’ quitting-related behaviors in the context of having a smoke-free indoor environment. The study aimed to investigate the impact of the smoke-free legislation on four quitting-related behaviors among youth smokers who called our Youth Quitline (YQ), the first smoking cessation hotline for youth smokers in Hong Kong. METHODS: Data obtained before the legislation (73 weeks) formed the pre- group and after 1 Jan 2007 (78 weeks) formed the post-legislation group. Callers who are ethnic Chinese, aged 12 to 25, smoked ≥ 1 cigarette in the past 30 days, and can communicate in Cantonese, were recruited to the YQ, received smoking cessation intervention delivered by trained peer counselors, and followed up at 6-month via telephone. Chi-square tests compared proportions of having at least 3 quit attempts, self-reported had stopped smoking in the past 7 days, change in stage of readiness to quit, and reduced daily cigarette consumption by at least half at 6-month in the pre- and post-legislation groups. RESULTS: A total of 254 and 288 youth smokers formed the pre and post-legislation groups. 73% were male, 61% were students, and 61% had mild nicotine dependency level. On average, they were 18 years old, started smoking at 14 years old and consumed 11 cigarettes daily. The post-legislation group were younger (post-legislation vs pre-legislation) (19 vs 17 years old; p < 0.001), started smoking earlier (14 vs 13 years old, P = 0.02), and more were students (55% vs 67%, p = 0.01). By intention-to-treat analysis, the post-legislation group had higher proportions in having at least 3 quit attempts in the past 3 months (47% vs 39%; p = 0.07), in self-reported successful quitting (27% vs 22%, p = 0.27), moving upward in stage of readiness to quit (28% vs 26%, p = 0.56), and reducing cigarette consumption by at least half including quitters (45% vs 36%, p = 0.04). CONCLUSION: Positive changes on the four individual quitting behaviors among the youth smokers who received counseling from our YQ were observed after the implementation of the legislation at 6-month follow up although the differences were not statistically significant except reduction in cigarette consumption. RESULTS: suggest the smoke-free legislation was successful in restricting smoking but was not enough to motivate and boost complete cessation among smoking adolescents. This highlights the needs to reinforce the smoke-free legislation by additional tobacco control policies that are sensitive to youth quitting, such as tobacco tax increase.