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Table 1.  Attitudes Toward Preventive Measures Related to All Tobacco Products by Political Viewpoint
Attitudes Toward Preventive Measures Related to All Tobacco Products by Political Viewpoint
Table 2.  Attitudes Toward Preventive Measures Related to Cigarettes by Political Viewpoints
Attitudes Toward Preventive Measures Related to Cigarettes by Political Viewpoints
1.
Blendon  RJ, Benson  JM, Schneider  EC,.  The future of health policy in a partisan United States: insights from public opinion polls.   JAMA. 2021;325(13):1253-1254. doi:10.1001/jama.2021.1147Google ScholarCrossref
2.
Politico, Harvard T.H. Chan School of Public Health. The American Public’s Priorities for the New President and Congress: Priorities Summary Topline. Published January 2021. Accessed March 30, 2021. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/94/2021/01/Politico-HSPH-Jan-2021-Poll-Priorities.pdf
3.
Office of Disease Prevention and Health Promotion. Healthy People 2020 Tobacco Use. Updated August 11, 2021. Accessed March 30, 2021. https://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use
4.
National Cancer Institute. Health Information National Trends Survey: About HINTS. Updated February 2021. Accessed March 30, 2021. https://hints.cancer.gov/about-hints/learn-more-about-hints.aspx
5.
Campaign for Tobacco-Free Kids. Tobacco Marketing That Reaches Kids: Point-Of-Sale Advertising and Promotions. Published April 15, 2021. Accessed March 30, 2021. https://www.tobaccofreekids.org/assets/factsheets/0075.pdf
6.
Centers for Disease Control and Prevention. Tobacco Industry Marketing. Updated May 14, 2021. Accessed March 30, 2021. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/marketing/
Research Letter
Public Health
September 15, 2021

Political Ideology and the Support or Opposition to United States Tobacco Control Policies

Author Affiliations
  • 1Department of Clinical Psychology, University of Texas at Tyler, Tyler
  • 2Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston
  • 3Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston
  • 4Division of Cancer Prevention and Population Science, University of Texas MD Anderson Cancer Center, Houston
JAMA Netw Open. 2021;4(9):e2125385. doi:10.1001/jamanetworkopen.2021.25385
Introduction

Recently, political attitudes toward health care policies in the US have grown more divided between liberals and conservatives.1 Such political division has affected the public’s attitudes and acceptance of health initiatives,2 which the tobacco industry could potentially exploit in its efforts to weaken tobacco control policies. Healthy People 20203 provides a framework for tobacco control, with initiatives such as limiting access to tobacco products, reducing tobacco advertising, and implementing hard-hitting antitobacco media campaigns. This cross-sectional study examined the associations between political ideology and support or opposition for various smoking policies. Such knowledge would allow us to develop interventions for a broader support of tobacco control.

Methods

We obtained data from cycle 4 of the 2020 Health Information National Trends Survey (HINTS), a nationally representative survey of US adults.4 Data collection was conducted from February 24 to June 15, 2020. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies. HINTS data is exempt from institutional review board approval and informed consent in accordance with the Common Rule and University of Texas MD Anderson Cancer Center policy because the data are deidentified and publicly available.

Outcomes of interest were the support or opposition for various tobacco control policies, including: (1) requiring stores to keep tobacco products out of the customer’s view, (2) requiring stores to keep tobacco advertisements away from their registers and windows, (3) prohibiting tobacco products from being advertised on social media, (4) requiring warning labels with both images and words on cigarette packs, and (5) requiring that movies with smoking carry an R rating.

A multinomial logistic regression analysis was used to identify how political ideology was associated with the odds of support or opposition to tobacco control policies. The explanatory variable, political ideology, was assessed with the survey question, “Thinking about politics these days, how would you describe your own political viewpoint?” The analysis was adjusted for age, sex, self-reported race and ethnicity, smoking status, education level, household annual income, and urban/rural residency. The statistical significance level was defined as 2-sided P < .05. Statistical analyses were performed using survey analysis procedures in SAS/STAT software version 9.4 (SAS Institute).

Results

The study sample included 3765 adults: 2204 women (weighted percentage, 51.4%), 2133 non-Hispanic White individuals (63.3%), and 436 (13.8%) current and 935 (23.0%) and former smokers. Furthermore, 828 (21.7%) self-reported as very conservative or conservative, 395 (11.8%) as somewhat conservative, 1200 (37%) as moderate, 368 (11.4%) as somewhat liberal, and 690 (18.2%) as very liberal or liberal. Compared with moderates, very liberal and liberal participants were more likely to say they strongly support or support requirements for stores to keep tobacco products out of the customer’s view (OR, 1.60; 95% CI, 1.11-2.32) and somewhat conservative participants were more likely to strongly oppose or oppose such requirements (OR, 2.33; 95% CI, 1.15-4.72) (Table 1). Likewise, compared with moderates, very liberal and liberal participants were more likely to strongly support or support requirements that stores keep tobacco advertisements away from registers and windows (OR, 1.70; 95% CI, 1.17-2.46) and somewhat conservative participants were more likely to strongly oppose or oppose such measures (OR, 2.76; 95% CI, 1.32-5.77).

Compared with moderates, very liberal and liberal participants were more likely to strongly support or support tobacco products not being advertised on social media (OR, 1.98; 95% CI, 1.36-2.88). This same group was also more likely to strongly support or support warning labels with both images and words on cigarette packs (OR, 1.68; 95% CI, 1.07-2.62), but were strongly opposed or opposed labeling movies with smoking with an R rating (OR, 1.64; 95% CI, 1.02-2.63) (Table 2).

Discussion

Our findings suggest that individuals identifying as liberals support removing tobacco products from customers’ view and keeping pro-tobacco advertisements away from registers and windows, while conservatives oppose these evidence-based tobacco control measures. Furthermore, liberals were more likely to support tobacco products not being advertised on social media and having warning labels with both images and words on cigarette packs; however, they opposed giving R ratings to movies that depict smoking.

These differing political viewpoints should be accounted for when educating the public against industry-sponsored pro-tobacco campaigns5 that currently exist in retail stores, packaging, movies, and social media. Furthermore, with the politicization of other public health policies increasing,1 it is important to keep raising awareness of the negative health effects tobacco has at the individual and population levels so these policies do not manifest into another partisan issue. We call for tailoring educational messages about the harms of tobacco to political subgroups that appeal to their societal values, as similar strategies have been shown to be effective with other health policies (eg, childhood obesity prevention). Tobacco advertisements have been especially potent for underserved populations6 (eg, racial/ethnic minority populations); therefore, preventing political ideology from becoming another vulnerability is critical as well. Study limitations included a low response rate and a cross-sectional design, which could not establish causal relationships.

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Article Information

Accepted for Publication: July 13, 2021.

Published: September 15, 2021. doi:10.1001/jamanetworkopen.2021.25385

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Shete SS et al. JAMA Network Open.

Corresponding Author: Sanjay Shete, PhD, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Pickens Academic Tower, Houston, TX 77030 (sshete@mdanderson.org).

Author Contributions: Dr S. Shete and Mr Yu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: S. S. Shete, S. Shete.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: S. S. Shete, S. Shete.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Yu.

Obtained funding: S. Shete.

Administrative, technical, or material support: S. Shete.

Supervision: S. Shete.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by the National Cancer Institute 5P30CA016672, Cancer Prevention and Research Institute of Texas grant award, RP170259, the Duncan Family Institute for Cancer Prevention and Risk Assessment, and the Betty B. Marcus Chair in Cancer Prevention (all awarded to Dr S. Shete).

Role of the Funder/Sponsor: The study funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Blendon  RJ, Benson  JM, Schneider  EC,.  The future of health policy in a partisan United States: insights from public opinion polls.   JAMA. 2021;325(13):1253-1254. doi:10.1001/jama.2021.1147Google ScholarCrossref
2.
Politico, Harvard T.H. Chan School of Public Health. The American Public’s Priorities for the New President and Congress: Priorities Summary Topline. Published January 2021. Accessed March 30, 2021. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/94/2021/01/Politico-HSPH-Jan-2021-Poll-Priorities.pdf
3.
Office of Disease Prevention and Health Promotion. Healthy People 2020 Tobacco Use. Updated August 11, 2021. Accessed March 30, 2021. https://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use
4.
National Cancer Institute. Health Information National Trends Survey: About HINTS. Updated February 2021. Accessed March 30, 2021. https://hints.cancer.gov/about-hints/learn-more-about-hints.aspx
5.
Campaign for Tobacco-Free Kids. Tobacco Marketing That Reaches Kids: Point-Of-Sale Advertising and Promotions. Published April 15, 2021. Accessed March 30, 2021. https://www.tobaccofreekids.org/assets/factsheets/0075.pdf
6.
Centers for Disease Control and Prevention. Tobacco Industry Marketing. Updated May 14, 2021. Accessed March 30, 2021. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/marketing/
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