Faculty Bibliography

This study aimed to gauge the Hong Kong's public support towards new e-cigarette regulation, and examine the associated factors of the support. We conducted a two-stage, randomized cross-sectional telephone-based survey to assess the public support towards the banning of e-cigarette promotion and advertisement, its use in smoke-free venues, the sale to people aged under 18, and regulating the sale of nicotine-free e-cigarettes. Adults (aged 15 years or above) who were never smoking (n = 1706), ex-smoking (n = 1712) or currently smoking (n = 1834) were included. Over half (57.8%) supported all the four regulations. Banning of e-cigarette promotion and advertisement (71.7%) received slightly less support than the other three regulations (banning of e-cigarette use in smoke-free venues (81.5%); banning of e-cigarette sale to minors (93.9%); sale restriction of nicotine-free e-cigarettes (80.9%)). Current smokers, and perceiving e-cigarettes as less harmful than traditional cigarettes or not knowing the harmfulness, were associated with a lower level of support. Our findings showed a strong public support for further regulation of e-cigarettes in Hong Kong. Current stringent measures on tobacco and e-cigarettes, and media reports on the harmfulness of e-cigarettes may underpin the strong support for the regulation.

Tobacco and alcohol use are strongly associated. This cross-sectional study examined the relationship of smoke-free law coverage and smoke-free bar law coverage with hazardous drinking behaviors among a representative sample of U.S. adult drinkers (n = 17,057). We merged 2009 National Health Interview Survey data, American Nonsmokers' Rights Foundation U.S. Tobacco Control Laws Database, and Census Population Estimates. Hazardous drinking outcomes included heavy drinking (>14 drinks/week for men; >7 drinks/week for women) and binge drinking (>/=5 drinks on one or more days during past year). Chi-square tests compared hazardous drinking by sociodemographic factors. Multivariable logistic regression models were used to examine if smoke-free law and bar law coverages were associated with hazardous drinking, controlling for sociodemographics and smoking status. Subset analyses were conducted among drinkers who also smoked (n = 4074) to assess the association between law coverages and hazardous drinking. Among all drinkers, smoke-free law coverage was not associated with heavy drinking (adjusted odds ratio (AOR) = 1.22, 95% confidence interval (CI) = 0.99-1.50) or binge drinking (AOR = 1.09, 95% CI = 0.93-1.26). Smoke-free bar law coverage was also found to be unrelated to hazardous drinking. Similar results were found among those drinkers who smoked. Findings suggest that smoke-free laws and bar laws are not associated with elevated risk for alcohol-related health issues.

INTRODUCTION: Waterpipe smoking has become increasingly popular in adolescents. We examined the association of waterpipe smoking with cigarette smoking susceptibility and nicotine dependence among adolescents in Hong Kong. METHODS: We analyzed the data of School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (US grades 7-12) in Hong Kong. Among never cigarette smokers (n=37,740), we conducted chi-square test to compare cigarette smoking susceptibility by current (past 30-day) waterpipe smoking status, and used multivariate logistic regression to examine the association between current waterpipe smoking and cigarette smoking susceptibility controlling for age, sex, peer cigarette smoking, and living with a cigarette smoker. Then we conducted chi-square test and multivariate logistic regression among current cigarette smokers (n=1694) to examine the relationship of current waterpipe smoking with two nicotine dependence outcomes, including heavier smoking (>/=5 cigarettes/day) and first cigarette within 30min of waking, controlling for demographics and the number of smoking days in the past 30days. RESULTS: Among never cigarette smokers, current waterpipe use was associated with cigarette smoking susceptibility (adjusted odds ratio [AOR]=3.58, 95% confidence interval [CI]: 1.61-7.97). Of current cigarette smokers, waterpipe use was associated with heavier smoking (AOR=1.56, 95% CI: 1.00-2.43) and first cigarette within 30min of waking (AOR=2.08, 95% CI: 1.35-3.19). CONCLUSIONS: Surveillance, prevention, and intervention programs should address waterpipe use in addition to cigarette smoking. Educational programs need to inform youth about the harmful and addictive effects of waterpipe smoking. Public health campaigns deglamourizing waterpipe use may help reduce waterpipe smoking among youth.

BACKGROUND: Advertising influences people's health behaviors. Tobacco companies have linked tobacco and alcohol in their marketing activities. We examined how depictions of alcohol were placed in lifestyle magazines produced by tobacco companies, and if these references differed depending on if the magazine was oriented towards men, women, or if it was unisex. METHODS: Content analysis of 6 different tobacco industry lifestyle magazines (73 issues), including 73 magazine covers, 1558 articles, 444 tobacco ads, and 695 non-tobacco ads. RESULTS: 14 of 73 (19%) magazine covers featured alcohol; 581 of 1558 (37%) magazine articles mentioned alcohol; 119 of 444 (27%) tobacco ads showed alcohol images; and 57 of 695 (8%) non-tobacco ads portrayed alcohol. Male-oriented magazines (Unlimited, CML, and Real Edge) contained the most alcohol references, and the references were mainly beer, mixed drinks, and liquor or spirits. Female-oriented magazines (All Woman and Flair) contained the fewest alcohol references, and wine and mixed drinks were the major types of alcoholic beverage portrayed. For unisex magazine (P.S.), the frequency of alcohol references fell between the male- and female-oriented magazines, and most frequently mentioned mixed drinks. CONCLUSIONS: Frequent depictions of smoking and drinking in tobacco industry lifestyle magazines might have reinforced norms about paired use of tobacco and alcohol among young adults. The pairing of tobacco and alcohol may particularly target young men. Anti-tobacco interventions need to address the co-use of tobacco and alcohol, change the social acceptability of smoking in any social settings, and tailor alcohol related anti-tobacco messaging by gender.

OBJECTIVES: To examine the prevalence of waterpipe smoking and its associated factors among adolescents in Hong Kong. METHODS: We analyzed data of the School-based Survey on Smoking among Students 2012/2013 from a representative sample of 45,857 secondary school students in Hong Kong (mean age 14.8, SD 1.9). We conducted Chi-square tests and t test to compare current (past 30 days) waterpipe users and nonusers by sociodemographic variables and other covariates. Univariate and multivariable logistic regression models were used to examine the factors associated with current waterpipe smoking. RESULTS: Overall, 1.2 % of students reported current waterpipe smoking, of whom 43 % reported concurrent use of cigarettes. Waterpipe was the most popular alternative tobacco product (non-cigarette) used by students. Current waterpipe smoking was associated with older age, male sex, higher self-perceived family financial status, poor knowledge about the harm of cigarette smoking, positive attitudes toward smoking, current cigarette smoking, other tobacco use, and alcohol consumption. CONCLUSIONS: Waterpipe smoking was the most popular alternative tobacco product among Hong Kong adolescents. Despite the low prevalence, it should be routinely monitored. Education programs and cessation interventions need to address waterpipe smoking in addition to cigarette smoking.

BACKGROUND: Little is known about electronic cigarette (e-cigarette) use among Chinese adolescents. We examined the prevalence of current (past 30-day) e-cigarette use and its associated factors in a large sample of adolescents in Hong Kong. METHODS: We analyzed data of the School-based Survey on Smoking among Students 2012/13 from a representative sample of 45,857 secondary school students (mean age: 14.8 +/- 1.9). We conducted chi-square tests and t-test to compare current e-cigarette use by covariates. We used multivariable logistic regression to examine the association between current e-cigarette use and demographic variables, parental smoking, peer smoking, knowledge about the harm of cigarette smoking, attitudes toward cigarette smoking, cigarette smoking status, use of other tobacco products, and alcohol consumption. RESULTS: Overall, 1.1% of students reported current e-cigarette use. Of e-cigarette users, 11.7% were never-cigarette smokers, 15.8% were experimental cigarette smokers, 39.3% were former cigarette smokers, and 33.2% were current cigarette smokers. Current e-cigarette use was associated with male sex, poor knowledge about the harm of smoking, cigarette smoking, use of other tobacco products, and alcohol consumption. CONCLUSIONS: Surveillance and intervention efforts should address a wide range of tobacco products, including e-cigarettes. Tobacco cessation programs should also address alcohol use collectively. Policies prohibiting e-cigarette sales to minors may help prevent e-cigarette uptake among adolescents.

OBJECTIVE: The goal of this study was to summarise the websites of electronic cigarette (e-cigarette) manufacturers in China and describe how they market their products. METHODS: From March to April 2013, we used two search keywords 'electronic cigarette' (Dian Zi Xiang Yan in Chinese) and 'manufacturer' (Sheng Chan Chang Jia in Chinese) to search e-cigarette manufacturers in China on Alibaba, an internet-based e-commerce business that covers business-to-business online marketplaces, retail and payment platforms, shopping search engine and data-centric cloud computing services. A total of 18 websites of 12 e-cigarette manufacturers in China were analysed by using a coding guide which includes 14 marketing claims. RESULTS: Health-related benefits were claimed most frequently (89%), followed by the claims of no secondhand smoke (SHS) exposure (78%), and utility for smoking cessation (67%). A wide variety of flavours, celebrity endorsements and e-cigarettes specifically for women were presented. None of the websites had any age restriction on access, references to government regulation or lawsuits. Instruction on how to use e-cigarettes was on 17% of the websites. CONCLUSIONS: Better regulation of e-cigarette marketing messages on manufacturers' websites is needed in China. The frequent claims of health benefits, smoking cessation, strategies appealing to youth and women are concerning, especially targeting women. Regulators should prohibit marketing claims of health benefits, no SHS exposure and value for smoking cessation in China until health-related, quality and safety issues have been adequately addressed. To avoid e-cigarette use for initiation to nicotine addiction, messages targeting youth and women should be prohibited.

INTRODUCTION: Electronic cigarettes (e-cigarettes) have gained popularity rapidly in the Western world but data in the East are scarce. We examined the awareness and ever use of e-cigarettes, and reasons for e-cigarette use in a probability sample of adults in Hong Kong. METHODS: Cross-sectional data were collected in 2014 from Chinese adults aged 15-65 in Hong Kong (819 never smokers, 800 former smokers, 800 current smokers) via computer-assisted telephone interviews (response rate: 73.8%). Analysis was limited to a subset of 809 respondents (i.e., 357 never smokers, 269 former smokers, 183 current smokers) who were randomly selected to answer questions on e-cigarettes. Chi-square analyses compared e-cigarette awareness and ever use by gender, age, education, and cigarette smoking status. Multivariable logistic regression examined if e-cigarette awareness was associated with demographic variables and cigarette smoking status. RESULTS: 75.4% of adults had heard of e-cigarettes, and 2.3% reported having used e-cigarettes. Greater awareness was associated with male gender and higher education. Ever use of e-cigarettes was higher among males (3.6%, p=.03), younger adults (aged 15-29, 5.2%, p=.002), and current cigarette smokers (11.8%, p<.001). Common reasons for using e-cigarettes were curiosity (47.4%), the stylish product design (25.8%), and quitting smoking (13.6%). CONCLUSIONS: Awareness of e-cigarettes was widespread in Hong Kong. Although the use of e-cigarettes was low, its relation with younger age and current smoking is of concern. Health surveillance of e-cigarette use is needed. Interventions should target young adults and cigarette smokers, and address the marketing messages, especially the effect of e-cigarettes on smoking cessation.

BACKGROUND: Electronic cigarettes (e-cigarettes) are being increasingly used. We examined the correlates associated with e-cigarette awareness, use and perceived effectiveness in smoking cessation among Chinese daily smokers in Hong Kong. METHODS: Daily smokers (N = 1,307) were recruited to a community-based randomised controlled trial ('Quit to Win') in 2014. Socio-demographic characteristics, conventional cigarette smoking status, nicotine addiction level, quit attempts, quit intention, e-cigarette awareness, use and perceived effectiveness on quitting were reported at baseline and 1-week follow-up. Multivariate logistic regression was used to identify factors associated with e-cigarette awareness, use and perceived effectiveness in quitting. RESULTS: Most smokers (82.6%, 95% CI 80.2%-84.9%) had heard about e-cigarettes, and 13.3% (11.3%-15.5%) ever used e-cigarettes. Most users (74.1%) and non-users (91.2%) did not perceive e-cigarettes as effective in quitting. Being younger and having a larger family income were associated with e-cigarette awareness. Being younger, a tertiary education and a stronger addiction to nicotine were associated with e-cigarette use, which was itself associated with lower levels of intention to quit and had no association with attempts to quit (P for trend 0.45). E-cigarette use, the last quit attempt being a month earlier, having made a quit attempt lasting 24 hours or longer and perceiving quitting as important were all associated with the perceived effectiveness of e-cigarettes in quitting (all P <0.05). CONCLUSIONS: Among community-recruited smokers who intended to quit, awareness of e-cigarettes was high, but most did not perceive e-cigarettes as effective in quitting. Correlates concerning e-cigarette perceptions and use will help to inform prospective studies, public education and policy on controlling e-cigarettes.