Beliefs about the Harmfulness of Heated Tobacco Products Compared with Combustible Cigarettes and Their Effectiveness for Smoking Cessation among Korean Adults

Abstract

Heated tobacco products (HTPs) have been widely used in Korea since their introduction in 2017. In this study, we investigated the perceptions of their relative harmfulness and smoking cessation effects. We performed an online survey in 7000 Koreans in 2018 (2300 males and 4700 females aged 20–69 years) by matching their age, sex, and provincial distribution. To investigate the factors causing HTPs to be perceived as less harmful than combustible cigarettes (CCs) and helpful for smoking cessation, we used multivariable logistic regression analyses. HTPs were less harmful than CCs in 16.8% of participants, particularly among HTP-only users and dual and triple users of HTPs, electronic cigarettes (ECs), or CCs than among CC-only users, those who were aged ≤ 34 years, males, and those with higher incomes. HTPs were reportedly helpful for smoking cessation in 11.2% of participants. Similar perceptions were more likely among HTP-only users, as well as dual and triple users than among CC-only users and adults with higher education/incomes. Although Korean adults generally had negative perceptions of the harmfulness and smoking cessation effects of HTPs compared with CCs, dual and triple users were more likely to have positive perceptions. Monitoring the use of multiple tobacco products and HTPs is a new challenge for Korean policymakers.

Perceived relative harm of heated tobacco products and electronic cigarettes and its association with use in smoke-free places: A cross-sectional analysis of Korean adults

“…However, the marketing by tobacco companies has led to a positive attitude towards HTPs among tobacco product users. Although many smokers understand that e-cigarettes or HTPs are not risk-free, they use e-cigarettes or HTPs due to their belief that there are health benefits over CCs 11 . The positive attitude toward HTPs is one of the independent predictors of initiation or continuation of HTP use.…”

“…Recent studies from various countries suggest that HTP poly-users may have higher nicotine dependence and are likely to underestimate their harmful effects to a greater extent than HTP-only users 20,[23][24][25][26] . A recent study of Korean adults showed that HTP-only users and polyusers of tobacco products were more likely to perceive HTPs as less harmful than CCs than cigarette-only smokers 11 .…”

“…However, the extensive and proliferating advertising of many tobacco companies has led the public, especially current tobacco users, to have a positive impression of e-cigarettes and HTPs. Although many smokers understand that HTPs are not risk-free, the prevalent belief that HTPs pose fewer health risks than CCs encourages them to use HTPs 11 . A recent study of Korean adults found that HTP-only users and poly-users of tobacco products were more likely to perceive HTPs as less harmful than CCs than CC-only smokers 11 .…”

“…Although many smokers understand that HTPs are not risk-free, the prevalent belief that HTPs pose fewer health risks than CCs encourages them to use HTPs 11 . A recent study of Korean adults found that HTP-only users and poly-users of tobacco products were more likely to perceive HTPs as less harmful than CCs than CC-only smokers 11 . Furthermore, a recent Japanese study showed that a considerable number of people used HTPs in places where tobacco smoking was not allowed 12 .…”

Usefulness of the smartphone app-based smoking cessation program for conventional cigarettes, heated tobacco products, and dual use: A retrospective study

“…20 Moreover, exclusive HTP users are more likely to report that HTP is helpful for smoking cessation than dual users are. 26 Exclusive HTP users might have higher motivation and awareness to quit using tobacco than traditional smokers, which might contribute to the high program adherence rate.…”