Wang Lijun, Chen Jianjiu, Ho Sai Yin, Leung Lok Tung, Wang Man Ping, Lam Tai Hing
School of Public Health, University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, P. R. China.
School of Nursing, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, P. R. China.
BMC Public Health. 2020 Sep 4;20(1):1349. doi: 10.1186/s12889-020-09422-w.
Tobacco advertisements have been banned in Hong Kong, but low intensity e-cigarette (EC) advertising can still be found in various media outlets. We investigated the associations between exposure to EC advertising and susceptibility to EC use in adolescents who had never used cigarettes or ECs, with potential mediation by attitudes towards ECs and the tobacco industry.
The School-based Smoking Survey 2016/17 assessed exposure to EC advertising in the past 30 days, attitudes towards ECs and the tobacco industry, susceptibility to EC use, and other covariates. Generalised linear mixed models and multiple mediation analysis methods were used in data analyses.
Among 7082 students (mean age 14.9 years), 28.8% reported exposure to EC advertising. Exposure was associated with being uncertain about the harm of EC use, being tolerant towards ECs, believing the tobacco industry is respectable, and being susceptible to EC use; the magnitudes of these associations increased with the number of types of advertising exposed (0, 1, and ≥ 2) (all p-values < 0.01). These attitudinal factors were in turn associated with EC use susceptibility (all p-values < 0.001). The perception that tobacco companies make youth smoke was not associated with the advertising exposure or EC use susceptibility. Of the total effects of EC advertising on use susceptibility, only 16.6% were mediated by attitudinal factors: perceived harm (3.1%), attitudes towards ECs (8.2%), and attitudes towards the tobacco industry (4.9%).
Even exposure to low intensity EC advertising was associated with susceptibility to EC use in adolescents who had never used cigarettes or ECs. The association was weakly mediated by tolerant attitudes towards ECs and the tobacco industry. The government should reinforce the regulations on EC advertising to protect adolescent health.
香港已禁止烟草广告，但在各类媒体上仍可发现低强度的电子烟广告。我们调查了从未使用过香烟或电子烟的青少年接触电子烟广告与使用电子烟易感性之间的关联，并探讨了对电子烟和烟草行业的态度在其中可能起到的中介作用。
2016/17学年校本吸烟调查评估了过去30天内接触电子烟广告的情况、对电子烟和烟草行业的态度、使用电子烟的易感性以及其他协变量。数据分析采用广义线性混合模型和多重中介分析方法。
在7082名学生（平均年龄14.9岁）中，28.8%的学生报告接触过电子烟广告。接触广告与对电子烟使用危害不确定、对电子烟持宽容态度、认为烟草行业值得尊敬以及使用电子烟的易感性相关；随着接触广告类型数量（0种、1种和≥2种）的增加，这些关联的强度也随之增加（所有p值均<0.01）。这些态度因素反过来又与使用电子烟的易感性相关（所有p值均<0.001）。认为烟草公司促使年轻人吸烟这一观念与广告接触或使用电子烟的易感性无关。在电子烟广告对使用易感性的总影响中，只有16.6%是由态度因素介导的：感知危害（3.1%）、对电子烟的态度（8.2%）以及对烟草行业的态度（4.9%）。
即使是接触低强度的电子烟广告，也与从未使用过香烟或电子烟的青少年使用电子烟的易感性相关。这种关联在一定程度上由对电子烟和烟草行业的宽容态度介导。政府应加强对电子烟广告的监管，以保护青少年健康。
