Public Attitudes about the Support for the Establishment of Smoke-free Environment

Jing Kong¹Yuan yuan Rong²Jing jing Yang³Ting ting Niu⁴Mingjun Xu⁵Xin xin Liu⁶Ting yu Duan⁷Liang Chen^8*

• ¹The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Shandong University, Jinan, China
• ²Department of Cardiology, Qingdao Municipal Hospital; Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao,, Qingdao Municipal Hospital Group, Qingdao, China
• ³Emergency department, Qilu Hospital, Shandong University, Jinan, China
• ⁴Jinan Vocational College of Nursing, Jinan, China
• ⁵The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong,, Qilu Hospital, Shandong University, Jinan, China
• ⁶Department of Ultrasound, Qilu Hospital, Shandong University, Jinan, China
• ⁷School of Journalism and Communication, Shijiazhuang, China,, Hebei Institute of Communication, Shijiazhuang, China
• ⁸Emergency Department,, Qilu Hospital of Shandong University, Jinan, China

This study investigated factors influencing public support for smoke-free environments in China. A cross-sectional survey was conducted among 11,031 adults (45.6% male, 54.4% female) between July and September 2021. The mean support score was 78.75 (SD = 26.996), with the highest scores observed in Central China (e.g., Shanxi, Henan). Multiple regression analysis revealed that being female (β = 5.505, 95% CI: 4.409–6.601), having an undergraduate education or above (β = 4.110, 95% CI: [2.475-5.746]), and having children (β = 1.554, 95% CI: 0.276– 2.833) were associated with stronger support. Conversely, being married (β = -3.375, 95% CI: - 4.849 – -1.900), frequent drinking (e.g., weekly: β = -5.275, 95% CI: -6.851 – -3.699), and higher levels of smoking dependence (e.g., severe: β = -21.968, 95% CI: -27.671 – -16.265) were associated with lower support. Psychosocial factors were also significant. Greater family health (FHS-SF: β = 0.645, 95% CI: 0.543–0.746) and social support (PSSS: β = 0.142, 95% CI: 0.092–0.193) predicted stronger support, while a higher BFI-10 total score (BFI-10: β = -0.559, 95% CI: -0.853 – -0.266) and unhealthy eating habits (EBS-SF: β = -0.328, 95% CI: -0.444 – -0.212) predicted weaker support. Subgroup analyses among smokers and ex-smokers confirmed the negative associations of drinking, tobacco dependence, and poor diet with support levels. These findings underscore the multifaceted nature of public support for smoke-free policies in China. Interventions that strengthen family and social support systems, alongside targeted strategies for key demographics, may be particularly effective in bolstering public endorsement.