Pro-smoking responses and attitudes due to point-of-sale tobacco displays in never smokers: A cross-sectional study in Hong Kong

INTRODUCTION: Never smokers’ responses to tobacco control policy are often overshadowed by the opposition from smokers and tobacco industry during policy advocacy and legislation. Very few studies have examined never smokers’ exposure to point-of-sale (POS) tobacco displays and their effects. Therefore, we investigated the exposure, pro-smoking responses due to and attitudes towards such displays in never smokers in Hong Kong. METHODS: We conducted two-stage, randomized cross-sectional telephone-based surveys in 2015 and 2016 of 1833 never-smoking adults. They were asked how often they noticed POS displays in the past 30 days (often, sometimes, never), whether they found POS displays attractive, felt encouraged to smoke, perceived POS displays as advertisements, and if they supported banning them. The distributions of the outcomes were analyzed by descriptive statistics with weighting to the general population. Risk ratios (RR) from Poisson regression models adjusted for sociodemographic characteristics were used to analyze the associations. RESULTS: Our results showed that, in never smokers, the younger were more likely to often notice POS displays (RR=0.80, 95% CI: 0.72–0.89, p<0.01). Finding POS displays attractive was associated with primary (RR=2.52, 95% CI: 1.51–4.22, p<0.01) and secondary education (RR=1.68, 95% CI: 1.16– 2.44, p=0.01) versus tertiary education. Often noticing displays was associated with perceived attractiveness (RR=1.90, 95% CI: 1.32–2.75, p<0.01). The positive association between often noticing displays and being encouraged to smoke was marginally significant (RR=4.05, 95% CI: 0.98–16.85, p=0.054). Respondents who often noticed POS displays (RR=0.87, 95% CI: 0.77–0.98, p=0.02) and did not perceive them as advertisements (RR=0.70, 95% CI: 0.61–0.98, p<0.01) showed less support on banning them than those who did not notice them. CONCLUSIONS: Frequent exposure to POS displays was associated with greater perceived attractiveness and lower support for banning them. A total ban on POS displays is needed to eliminate the advertising and normalization effect of POS displays.