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
Yongda S. Wu 1
Man Ping Wang 1  
Sai Yin Ho 2
Antonio Kwong 3
Vienna Lai 3
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School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
Hong Kong Council on Smoking and Health, Wan Chai, Hong Kong
Man Ping Wang   

School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong
Publish date: 2019-08-28
Tob. Induc. Dis. 2019;17(August):61
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.

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.

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).

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.

We thank the respondents for their support and the Public Opinion Program, University of Hong Kong, for conducting the survey.
The authors declare that they have no competing interests, financial or otherwise, related to the current work. M.P. Wang reports grants from Hong Kong Council on Smoking and Health, during the conduct of the study. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
This work was supported by the Hong Kong Council on Smoking and Health ( by funds to MPW. The funding organization had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
M.P.W. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: M.P.W., S.Y.H., Y.T.C., A.K., V.L. and T.H.L. Obtained funding: M.P.W., S.Y.H., Y.T.C., and T.H.L. Survey administration: M.P.W. and Y.T.C. Statistical analysis: Y.S.W. and M.P.W. Drafting of the manuscript: Y.S.W. and M.P.W. Critical revision of the manuscript for important intellectual content and final approval of the manuscript by all the authors.
Not commissioned; externally peer reviewed.
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