Association of exposure to messages promoting e-cigarettes with attitudes towards e-cigarettes and tobacco companies among adolescents

Abstract

Background Exposure to messages promoting e-cigarettes (ECs) may influence adolescents’ attitudes towards ECs and in turn attitudes towards the tobacco companies. We investigated these associations in Hong Kong adolescents. Methods In a cross-sectional school survey in 2016/17, 8700 secondary school students reported any exposure to messages promoting ECs in the past 30 days, whether EC use harms health, their attitudes towards EC use, whether tobacco companies are a respectable industry and whether tobacco companies try to get youth to smoke. Logistic regression was used to investigate the associations in never cigarette and EC users adjusting for school grade, sex, exposure to secondhand smoke at home and outside home, and clustering effect. Results 7082 students (mean age 14.8 years; 54.0% boys) had never used cigarettes or ECs. Among them, 28.9% were exposed to messages promoting ECs, 68.0% considered ECs definitely harmful, 75.6% were negative towards EC, 27.0% respected tobacco companies, and 49.1% thought that tobacco companies try to get youth to smoke. Exposed students were less likely to consider ECs definitely harmful (adjusted odds ratio 0.86, 95% CI 0.77-0.96) and less likely to hold negative attitudes towards EC use (0.82, 0.73-0.93). Those who considered ECs definitely harmful were less likely to respect tobacco companies (0.71, 0.63-0.79) and more likely to believe tobacco companies try to get youth to smoke (1.25, 1.13-1.39; those who held negative attitudes towards EC use were less likely to respect tobacco companies (0.43, 0.38-0.48) and more likely to believe tobacco companies try to get youth to smoke (1.52, 1.36 -1.70). Conclusions Although tobacco advertising is banned in Hong Kong, one-third of adolescents were still exposed to messages promoting ECs in the past 30 days. Such exposure was associated with positive attitudes towards ECs, which in turn were associated with positive attitudes towards tobacco companies. Portrayed as less harmful, ECs will help normalise smoking and raise respectability of the tobacco industry. These findings support a total ban of ECs in Hong Kong.