Assessing the knowledge, attitudes and perceptions of tobacco-associated diseases and how it is influenced by tobacco products advertisement, promotion and sponsorship while enforcing a strong and comprehensive ban in Panama: a cross-sectional study

OBJECTIVES: Assessing the knowledge, attitudes and perceptions (KAP) of tobacco-associated diseases, and how it is influenced by tobacco products' advertisement, promotion and sponsorship (TAPS) while enforcing a strong and comprehensive ban. DESIGN: The Panamanian implementation of the Global Adult Tobacco Survey: an international standardised cross-sectional survey study. SETTING: National Panamanian population aged between 15 years and 29 years old. PARTICIPANTS: There were 4796 responding participants (n=905 830 in the expanded sample). PRIMARY AND SECONDARY OUTCOMES: An index was developed using factorial analysis using TAPS and KAP variables. The primary outcomes were: (1) The national median index value. (2) The index value stratified by sex, age, occupation, income quintile and geographical areas. (3) The first and second factor loadings (FFL and SFL, respectively) for variables included in the KAP index. RESULTS: Fifteen out of the 16 variables comprising the index were variables related to KAP and one variable was related to TAPS. The top three variables according to their FFL were ‘KAP that cigarette is associated to …’: (1) ‘… bladder cancer’. (2) ‘… breast cancer’. (3) ‘… stomach cancer’. The top three variables according to the SFL were ‘KAP that cigarette is associated to …’: (1)‘… chronic bronchitis’. (2) ‘… myocardial infarction’. (3) ‘… lung cancer’. Illegal tobacco advertisement in posters was the only TAPS variable included in the index. The national KAP index value was 0.26. Our results show that current smokers, teens, men, people with the lowest income quintile, and those living in Guna Yala Indigenous Territory (health region with the highest smoking prevalence) had a lower median value than the national median. CONCLUSIONS: Men, young adults and deprived youth had the lowest median KAP index. Illegal TAPS had no influence on the KAP of tobacco-associated diseases when a strong and comprehensive ban is enforced.