Knowledge and attitudes towards tobacco tax and graphic health warning laws and smoking behaviors of outpatients in a tertiary hospital and a community clinic in Manila, Philippines

Following the implementation of the Sin Tax Reform Law of 2012 and the Graphic Health Warning Law of 2014 in the Philippines, this study assessed the knowledge on smoking and its related laws, described attitudes towards smoking, graphic warnings, excise tax, and government intervention, and explored self-reported smoking behaviors and factors influencing these. Convergent mixed-methods study. A total of 393 survey respondents and 30 in-depth interviewees were recruited, both from outpatient clinics of a tertiary-level university hospital and a primary-level urban health center. Descriptive statistics were obtained from quantitative data, and a Chi-square test was done to compare types of smoking behaviors. Thematic analysis by extracting codes and grouping into themes was done for qualitative data. Respondents included 249 (63%) never smokers, 60 (15%) former smokers, 59 (15%) quit attempters, and 25 (6%) persistent smokers. Never smokers, former smokers, and quit attempters had better knowledge and more positive attitudes compared to current smokers. Having a family or community member suffering from a smoking-related illness might have significantly shaped the decision to avoid or quit smoking. While both excise taxes and graphic warnings helped in smoking cessation and deterrence, addiction was a major barrier, causing respondents to ignore health and cost-related information about smoking, as well as the graphic warnings. The laws were effective in preventing smoking initiation among never-smokers and in supporting cessation among former smokers and quit attempters. For current smokers, the laws still served as important deterrents, but multi-level strategies may be needed to promote smoking cessation.