Policy Awareness Outweighs Health Knowledge: A Structural Equation Modeling Analysis of Tobacco Quit Intention Determinants in Vietnam’s Provincial Global Adult Tobacco Survey 2024

Tobacco use remains a critical public health challenge in Vietnam, contributing to significant health and economic burdens. Despite comprehensive tobacco control policies, cessation rates remain low. This study investigates how tobacco control awareness, media exposure, and health knowledge influence quit intentions among Vietnamese smokers. A cross-sectional analysis of 17 387 adult current smokers from the 2024 Provincial Global Adult Tobacco Survey (PGATS) was conducted. Structural equation modeling (SEM) tested direct and mediated pathways between tobacco control awareness, anti-/pro-tobacco media exposure, health knowledge, and quit intentions, adjusting for age and gender. Multiple imputation addressed missing data (3.7%), and model fit was assessed using AIC, BIC, and SRMR. Health knowledge and anti-tobacco media exposure were the strongest predictors of quit intentions (β = 0.107, P = 0.002; β = 0.250, P < 0.001, respectively). Pro-tobacco media exposure significantly strengthened quit intentions among smokers already planning to quit (interaction β = 0.445, P = 0.026). Multi-group analyses revealed health knowledge and media effects were significant only among male smokers. Educational stratification showed lower-educated smokers benefited more from health information, while higher-educated smokers responded better to anti-tobacco media campaigns. Individual-level health knowledge and anti-tobacco media campaigns drive quit intentions among Vietnamese smokers. The pro-tobacco media paradox, operating through psychological reactance among motivated quitters, highlights opportunities for targeted counter-advertising. Gender and educational disparities underscore the need for tailored interventions: clear health messaging and sophisticated media campaigns.