Psychosocial Factors, Smoke-Free Restrictions, and Media Exposure in Relation to Smoking-Related Attitudes and Behaviors among Adults in Armenia and Georgia

Abstract

Background: Perceived harm, social influences, smoke-free policies, and media exposure have been understudied in relation to tobacco-related attitudes/behaviors in aggregate or in low and middle-income countries; thus, this study examined these factors collectively in relation to smoking-related outcomes among Armenian and Georgian adults. Methods: Using 2018 cross-sectional survey data (n = 1456), multivariable regression analyses examined these factors in relation to smoking status, perceived harm among nonsmokers, and readiness to quit and past-year quit attempts among smokers. Results: Significant predictors (p < 0.05) of current smoking (27.3%) included lower perceived harm, more smoking friends, and fewer home and vehicle restrictions. Among nonsmokers, more home and restaurant/bar restrictions, fewer vehicle restrictions, greater anti-tobacco media exposure, and less pro-tobacco media exposure predicted greater perceived harm. Among smokers, greater perceived social acceptability of smoking, less anti-tobacco media exposure, and greater pro-tobacco media exposure predicted readiness to quit (12.7% of smokers). More smoking friends, more home restrictions, less anti-tobacco media exposure, and greater pro-tobacco media exposure predicted past-year quit attempts (19.2%). Conclusions: Findings support the importance of smoke-free policies but were counterintuitive regarding the roles of social and media influences, underscoring the need to better understand how to address these influences, particularly in countries with high smoking rates.

Associations Between Pro/Anti-Tobacco Media and Messaging Exposure and Knowledge and Support of Smoke-Free Policy Among Adults in Armenia and Georgia

“…Regarding tobacco advertising, in bivariate analyses, e-cigarette and HTP advertisement exposure correlated with less support of the smoke-free policies applying to ATPs and various settings. However, there was no association between cigarette advertisement exposure and knowledge or support, which may be due to cigarette advertising being less salient, given the less novel nature of the product relative to e-cigarettes and HTPs 34. In multivariable analyses, only the association between HTP advertisement exposure and lower support for the policies to apply to various settings remained significant after adjusting for other variables.…”

“…However, there was no association between cigarette advertisement exposure and knowledge or support, which may be due to cigarette advertising being less salient, given the less novel nature of the product relative to e-cigarettes and HTPs. 34 In multivariable analyses, only the association between HTP advertisement exposure and lower support for the policies to apply to various settings remained significant after adjusting for other variables. Given the targeted marketing tactics the tobacco industry performs (ie, targeting tobacco users who often represent disproportionately impacted minority populations 13,16,40 ), it is plausible that the associations between tobacco advertising exposure and knowledge/support of the policies may be, in part, accounted for by current smoking status.…”

“…31 Research conducted in Armenia and Georgia indicates that less anti-tobacco media exposure and greater pro-tobacco media exposure were associated with less tobacco-related perceived harm to health among nonsmokers and, among smokers, being less ready to quit smoking and less likely to have made past-year quit attempts. 34 These associations may be, in part, due to shifts in perceptions, including risks and social norms, that may be impacted by media exposure and play key roles in influencing one's knowledge about and support for smoke-free policies, which impact policy adoption and compliance. 22,23 The high rates of tobacco use and SHSe in Armenia and Georgia and the recent implementation of their national comprehensive smoke-free policies make data from these countries highly relevant to understanding smoke-free legislation.…”