Elsevier

Health Policy

Volume 122, Issue 8, August 2018, Pages 929-935
Health Policy

Public support for tobacco control policies: The role of the protection of children against tobacco

https://doi.org/10.1016/j.healthpol.2018.05.004Get rights and content

Highlights

  • Support for protection of children relates to tobacco policy support.

  • This relationship is not dependent on certain ideological beliefs.

  • This relationship also exists, though less strongly, among smokers.

  • Advocates may use a childframe to enhance tobacco control policy support.

Abstract

Introduction

In many countries, health advocates aim to increase public support for tobacco control policies by framing these policies in terms of child protection. We examined whether support for the protection of children is indeed associated with support for tobacco control policies, even among smokers, opponents of state intervention and opponents of a governmental role in tobacco control.

Methods

We used a survey on a representative sample of Dutch adults of 18 years and older (n = 1631). The survey measured respondents’ support for banning tobacco displays, raising the age of sale for tobacco to 21 years and limiting tobacco sales to specialized shops. Regression analyses were done to assess the association with respondents’ support for the protection of children against tobacco. In further analyses, subgroup interactions were added.

Results

Respondents’ support for the protection of children against tobacco with legislation was positively related to support for all three policies. Associations were weaker for smokers (except for raising the age of sale) but similar for opponents of state intervention and opponents of a governmental role in tobacco control.

Conclusion

This is the first paper to empirically support the idea that emphasizing the need to protect children against tobacco enhances support for tobacco control policies. This ‘child effect’ is effective in all segments of the population, albeit somewhat weaker among smokers.

Introduction

Most social scientists acknowledge the association between public opinion and public policy [1]. This so called ‘policy responsiveness’ has been established in the domain of tobacco control in a variety of European countries and US states, where smoke-free legislation was found to follow public preferences [[2], [3], [4]]. Public policies are a major determinant of public health [5] and are therefore crucial in addressing smoking induced diseases and morbidity. According to the WHO’s Framework Convention for Tobacco Control (FCTC) public policies that are unpopular may ‘need to be altered or reframed with better advocacy and communication strategies’ [6]. How a policy is described or ‘framed’ can ‘determine the extent to which it has popular or political support’ and the language used shapes the way people come to think about it [7]. Framing can be understood as narratives that are both diagnostic and prescriptive: per policy these narratives tell what needs to be changed or improved, and how this may be addressed [8].

A frame used by many tobacco control organizations, is the protection of children against tobacco [9,10]. There are some indications from the literature that a child-frame is related to support for prospective tobacco control policies. Scholars have observed that tobacco control policy support is higher for policies that explicitly target children [11], that policymakers purposefully use a child-frame in opinion polls to yield high public support for a tobacco display ban [12,13] and that reducing youth opportunities to smoke and establishing positive role models for children are reasons to support smoke-free parks [14]. However, scholars have not yet empirically tested this ‘child-effect’ and how it relates to tobacco control policy support among the general public. In order to better understand how these two concepts are related, we examine how people’s support for the protection of children is related to their support for three prospective tobacco control retail policies: banning tobacco displays at point of sale, raising the age of sale to 21 and limiting sales to specialized shops. These supply-side policies are regarded as logical next steps in tobacco control efforts and are thus far only adopted by a few progressive countries and US states and cities [[15], [16], [17]]. Moreover, these policies can readily be framed with the aim to prevent youth access and exposure to tobacco products.

The degree of policy support differs for different segments of the population. Smoking status is found to be related to tobacco control policy support, as smokers generally demonstrate less support for tobacco control policies than non-smokers [[18], [19], [20], [21], [22]]. Even though support for tobacco control policies has been found to be much lower among smokers, smokers may support policies more if they think children should be protected against tobacco.

Next to smoking status, having certain ideological views may be of influence on support for tobacco control policies. It has been demonstrated that such views are of influence on the level of support for tobacco control policies, but it was also noted that using a simplified left-right wing preference scale may not reflect more nuanced ideological beliefs [23]. In this paper we use ideological dimensions that go beyond the left-right wing divide and measure beliefs about state intervention and beliefs about the proper role of government in relation to tobacco control. We expect less support from individuals that oppose state intervention since opponents of tobacco control policies typically argue that the government should not interfere with the private lives of citizens and that citizens are themselves responsible for their choices and actions [24]. However, possibly, opponents of state intervention might as well support tobacco control policies when they think children should be protected against tobacco.

Some scholars argue that a distinction can be made between symbolic and operational political ideology [25]. Whereas the former aspect of ideology is largely understood in terms of self-identification in which respondents identify themselves as being liberal or right-wing, the latter aspect of ideology is more specific and issue-based [25]. There have been cases where individuals were identified as being conservative, yet were in favor of specific ‘big government’ policies, which was incongruent [26]. Since tobacco has unique product features, such as its addictiveness and severe health consequences [27], it may well be the case that individuals who oppose general state intervention, may still support governmental intervention with regard to tobacco control. Therefore we also assess specific, issue-based ideological beliefs: opposition to a governmental role in tobacco control. Furthermore, we assess whether individuals having such beliefs will be more supportive of tobacco control policies when they think children should be protected.

The aim of this study is two-fold: first, we test whether support for the protection of children is positively associated with support for three prospective tobacco control policies. Second, we assess whether this association works as well within groups that are expected to have less policy support: smokers, opponents of general state intervention and opponents of a governmental role in tobacco control.

Section snippets

Data

The data were derived from a Dutch public opinion poll, commissioned by the Dutch Cancer Society and collected by Kantar Public. The sample was drawn from an online panel which consists of more than 120,000 respondents who participate in survey research on a regular basis. Panel members are actively recruited by Kantar Public in case a certain group is underrepresented. A total number of 2535 stratified invitations were sent and 1631 respondents participated, which resulted in a response rate

Descriptive statistics

Table 1 gives an overview of descriptive statistics. Fig. 1 shows policy support for the three prospective policies on a five point Likert scale as a function of support for the protection of children. Fig. 2 shows a chart of the support per policy measure of all investigated subgroups (the percentage of respondents per group that indicated ‘Agree’ and ‘Completely agree’ to the policy support questions). Groups in this figure were based on smoking status (0 = non-smoker, 1 = smoker) and a

Discussion

Support for the protection of children against tobacco with legislation was positively associated with support for three prospective tobacco control retail policies. These relationships were also observed for opponents of state intervention and opponents of a governmental role in tobacco control although the last group had less absolute policy support. There were interactions with smoking status indicating that the association between believing in the need to protect children against tobacco

Conclusion

People’s belief in the need to protect children against tobacco with legislation is positively related to support for prospective tobacco control policies. This means that tobacco control advocates and governments may use a child-frame to increase policy support.

Conflict of interest

None declared.

Funding

This work is part of the SILNE-R project, which is supported by the European Commission (EC) [grant number 635056].

Acknowledgements

The authors would like to thank Math Candel for helping with the statistical analyses and the Dutch Cancer Society for using their data.

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