Tobacco Industry Denormalization Beliefs in Hong Kong Adolescents

Background: Tobacco industry denormalization (TID) seeks to expose the industry's misconducts. Research on TID beliefs, meaning negative attitudes toward the tobacco industry (TI), may inform TID programs, but was limited to western populations. We investigated TID beliefs and their association with smoking and sociodemographic characteristics in Hong Kong adolescents. Methods: In a school-based cross-sectional survey of 14 214 students (mean age 15.0 years, 51.5% boys), TID beliefs were assessed by two questions: (1) whether the TI was respectable and (2) whether the TI tried to get youth to smoke, each with four options from definitely no to definitely yes. Smoking susceptibility and behaviors were also assessed. Sociodemographic characteristics included age, sex, perceived family affluence, highest parental education, numbers of co-residing smokers, and school-level smoking prevalence. Results: Of all students, 77.6% considered the TI not respectable and 56.6% believed that the TI tried to get youth to smoke. Stronger TID beliefs were inversely associated with smoking susceptibility and behaviors. For example, students considering the TI definitely not respectable (vs. definitely yes) were 56% (95% confidence intervals [CI] = 45% to 66%), 49% (95% CI = 41% to 56%), and 53% (95% CI = 36% to 65%) less likely to be susceptible to smoking (among never-smokers) and be ever- and current smokers, respectively. Of all correlates examined, only younger age and having no co-residing smoker were associated with TID beliefs. Conclusions: Substantial proportions of Hong Kong adolescents did not hold TID beliefs, but those who did were less likely to smoke. Our results suggest that TID programs may help reduce adolescent smoking.