Public acceptability of tax, nudge, and health education policies targeting health behavior change in China.

Abstract

Background: Public health policies are crucial for shaping public health practices and promoting healthier lifestyles; however, successful implementation and widespread adoption of these policies largely depend on their public acceptability.

Purpose: This study aims to understand the public acceptability of tax, nudge (design, size, and availability), and health education policies targeting health behavior change including reducing tobacco use, alcohol consumption, snack consumption, beverage consumption, and increasing physical activity among Chinese citizens, along with the factors that influence public acceptability of different public health policies.

Methods: The cross-sectional study was conducted in the WJX online platform between January and March 2024, involving 2409 participants who were randomly assigned to 23 groups. Besides the demographics, the policy acceptability, perceived policy effectiveness, engagement in health behaviors, and social value orientation were also assessed. One-way Analysis of Variance (ANOVA) and post hoc tests were used to examine differences in policy acceptability across various policies and behaviors. The t-tests and ANOVA analyses were conducted to compare policy acceptability among participants with different characteristics. Multiple linear regression was performed to reveal the impact of strategies used, perceived effectiveness, social value orientation, and socioeconomic status on policy acceptability.

Results: The overall policy acceptability rate was 79.1%. "Design" strategies achieved the highest acceptability (86.8%), followed by health education (82.0%). Tax policies had the lowest acceptability (71.0%). Policies targeting smoking (83.7%) and physical activity (85.8%) were highly accepted. Smokers showed lower acceptability for policies to control smoking compared to non-smokers (75.9% vs. 85.7%, P = .015). Individuals who rarely exercise had lower acceptability for policies to promote physical activity compared to those who were physically active (77.1% vs. 88.3%, P = .019). Those with a stronger "proself" orientation or higher socioeconomic status tended to report lower acceptability of public health policies to promote healthy eating.

Conclusions: Integrating traditional education with tailored nudges could be an effective public health promotion strategy in China. Future pilot programs leveraging these findings could enhance the public acceptability of such policies.