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Tobacco industry denormalisation beliefs in Hong Kong adolescents.

Introduction: Tobacco industry denormalisation (TID) seeks to expose the industry's misconducts. Research on TID beliefs, meaning negative attitudes towards the tobacco industry (TI), may inform TID programmes, 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 14214 students (mean age 15.0 years, 51.5% boys), TID beliefs were assessed by two questions: (i) whether the TI was respectable and (ii) whether the TI tried to get youth to smoke, each with 4 options from "definitely no" to "definitely yes". Smoking susceptibility and behaviours 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 behaviours. For example, students considering the TI definitely not respectable (vs definitely yes) were 56% (95% CI 45-66%), 49% (41-56%), and 53% (36-65%) 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 programmes may help reduce adolescent smoking.

Implications: The TI's misconducts and responsibility for the tobacco epidemic were not well known by Hong Kong adolescents. TID beliefs in this population were inversely associated with smoking. These findings suggest that TID programmes in local adolescents may be of value. The investigation of TID beliefs' correlates found that socio-economic status and school-level smoking prevalence was not associated with TID beliefs. This suggests that local TID programmes targeting adolescents in general, e.g., mass media campaigns, may be more appropriate than those targeting particular schools or selected groups of adolescents.

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