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Fearon IM, Cordery SF, Fitzpatrick M, Weaver S, Stevenson M, Grandolfo E, Malt L, Thompson K, Nahde T. A Scoping Review of Behavioural Studies on Heated Tobacco Products. Cureus 2024; 16:e65773. [PMID: 39211653 PMCID: PMC11361622 DOI: 10.7759/cureus.65773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Heated tobacco products (HTPs) are electronic devices that heat tobacco sticks to temperatures much lower than those which cause pyrolysis and combustion in cigarettes. While this electrical heating causes the formation of an inhalable aerosol which contains nicotine, the aerosol from HTPs contains significantly fewer and lower levels of the harmful and potentially harmful chemicals found in cigarette smoke. As a result, HTP use potentially conveys reduced risks to health compared to cigarette smoking. While this relative reduction in individual health risk is becoming clearer, what is less certain is the impact of HTPs on overall population‑level health, taking into account both the potential positive impact on adult smokers who completely switch to using HTPs and any unintended impacts such as use by tobacco non‑users and particularly by youth. The aim of this scoping review was to collate and evaluate the published scientific evidence to date, with a cut‑off of 1 January 2024, investigating the impact of HTPs on population‑level health. This evaluation suggests that HTP use is almost exclusively observed among those with a history of cigarette smoking, and there is a growing body of evidence for the ability of HTPs to provide support for adult smokers to transition away from cigarette smoking, in the absence of any significant "gateway" into tobacco use initiation. Many studies have reported a significant degree of dual use of cigarettes and HTPs, and efforts to assess the reasons for such patterns of use, whether these provide overall exposure reductions, and whether dual use acts as a bridge towards a complete transition away from cigarette smoking, requires further investigation. In addition, correction of the widespread and increasing misperceptions of HTPs among adult smokers is recommended to promote HTP uptake as a potentially less harmful alternative to smoking in this population.
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Affiliation(s)
- Ian M Fearon
- Scientific Research, whatIF? Consulting Ltd., Harwell, GBR
| | - Sarah F Cordery
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | | | - Sarah Weaver
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Matthew Stevenson
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Erika Grandolfo
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Layla Malt
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Keith Thompson
- Scientific Consultant, Elucid8 Holdings Ltd., Newtownabbey, GBR
| | - Thomas Nahde
- Group Science and Regulatory Affairs, Imperial Brands Reemtsma, Hamburg, DEU
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Sussman RA, Sipala F, Emma R, Ronsisvalle S. Aerosol Emissions from Heated Tobacco Products: A Review Focusing on Carbonyls, Analytical Methods, and Experimental Quality. TOXICS 2023; 11:947. [PMID: 38133348 PMCID: PMC10747376 DOI: 10.3390/toxics11120947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
We provide an extensive review of 17 independent and industry-funded studies targeting carbonyls in aerosol emissions of Heated Tobacco Products (HTPs), focusing on quality criteria based on the reproducibility of experiments, appropriate analytic methods, and puffing regimes. Most revised studies complied with these requirements, but some were unreproducible, while others failed to consider analytical variables that may have affected the results and/or produced unrealistic comparisons. We also provide a review of the literature on the physicochemical properties of heated tobacco and HTP aerosols, as well as the evaluation of HTPs by regulatory agencies, addressing various critiques of their relative safety profile. The outcomes from the revised studies and regulatory evaluations tend to agree with and converge to a general consensus that HTP aerosols expose users to significantly lower levels of toxicity than tobacco smoke.
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Affiliation(s)
- Roberto A. Sussman
- Institute of Physical Sciences, National Autonomous University of Mexico UNAM, Mexico City 04510, Mexico
| | - Federica Sipala
- Department of Drug and Health Sciences, University of Catania, 95123 Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), 95123 Catania, Italy
| | - Rosalia Emma
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), 95123 Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Simone Ronsisvalle
- Department of Drug and Health Sciences, University of Catania, 95123 Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), 95123 Catania, Italy
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Noguchi S, Ishimaru T, Fujino Y, Yatera K, Tabuchi T. Association of cigarette smoking with increased use of heated tobacco products in middle-aged and older adults with self-reported chronic obstructive pulmonary disease, asthma, and asthma-COPD overlap in Japan, 2022: the JASTIS study. BMC Pulm Med 2023; 23:365. [PMID: 37777737 PMCID: PMC10542693 DOI: 10.1186/s12890-023-02668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Smoking cessation is the most important intervention in chronic obstructive pulmonary disease (COPD), asthma, and asthma-COPD overlap (ACO); however, high rates of current cigarette smoking are observed in adults with these respiratory diseases. Meanwhile, rapidly increasing use of heated tobacco products (HTPs) is observed in Japan; however, the status of HTPs use has not been fully understood in adults with COPD, asthma, and ACO. This study aimed to reveal the association between COPD, asthma, and ACO and HTPs use in adults. METHODS Data on Japanese individuals ≥ 40 years old obtained from the Japan Society and New Tobacco Internet Survey were analyzed. The prevalence of HTPs use in adults with COPD, asthma, and ACO, among individuals categorized into three groups according to cigarette smoking (never, former, and current), was calculated and the relationship between each disease and HTPs use were evaluated. The clinical diagnosis of these diseases was based on the self-reported diagnosis, as obtained from questionnaires. RESULTS A total of 19,308 individuals were included. The proportions of never, past, and current cigarettes smokers were 10,900 (56.5%), 4,903 (25.4%), and 3,505 (18.2%), respectively, and that of HTPs use was 1,813 (9.4%). In current cigarettes smokers, the adjusted odds ratios (ORs) of HTPs use was 2.88 (95% CI [confidence interval], 1.86-4.47), 1.23 (95% CI, 0.99-1.52), and 5.81 (95% CI, 3.12-10.82) in adults with COPD, asthma, and ACO compared to those without these respiratory diseases, respectively. Meanwhile, in past cigarettes smokers, the adjusted ORs of HTPs use was 0.51 (95% CI, 0.24-1.08), 0.69 (95% CI, 0.53-0.88), and 0.25 (95% CI, 0.06-1.07) in adults with COPD, asthma, and ACO, respectively. CONCLUSIONS HTPs use is more prevalent among current cigarettes smokers with COPD, asthma, and ACO compared to those without these respiratory diseases. Complete cessation of smoking both cigarettes and HTPs is the only way to achieve complete smoking cessation, therefore, adults with COPD, asthma, and ACO need to make greater efforts to quit smoking.
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Affiliation(s)
- Shingo Noguchi
- Department of Respiratory Medicine, Tobata General Hospital, 1-3-33, Fukuryugi, Tobata-Ku, Kitakyushu-City, Fukuoka, 804-0025, Japan.
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu-City, Fukuoka, 807-8555, Japan.
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu-City, Fukuoka, 807-8555, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu-City, Fukuoka, 807-8555, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-Ku, Kitakyushu-City, Fukuoka, 807-8555, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-Ku, Osaka, 541-8567, Japan
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Otsuka Y, Kaneita Y, Itani O, Matsumoto Y, Hatori Y, Imamura S. Awareness, Attitudes, and Concerns Regarding Heated Tobacco Products Among Physicians in Japan. J Epidemiol 2023; 33:441-449. [PMID: 35370227 PMCID: PMC10409525 DOI: 10.2188/jea.je20210470] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/13/2022] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND New tobacco products, particularly heated tobacco products (HTPs), have been introduced across several international markets as alternatives to combustible products, such as cigarettes. However, there are limited studies on physicians' perceptions of HTPs. This study analyzes the awareness of HTPs among physicians and assesses their concerns and attitudes toward patients using HTPs. METHODS A self-administered questionnaire was sent to a sample of 7,500 member physicians (6,000 male and 1,500 female) from the Japan Medical Association (JMA). The smoking status of physicians was categorized as never smokers, ever HTP smokers, current HTP smokers, and ever and current smokers of other products. Physicians' awareness and attitudes toward patients using HTPs were analyzed using descriptive statistics. The correlation between the outcomes was examined using logistic regression models, whereas physicians' concerns about HTPs were analyzed using descriptive statistics. RESULTS Data were obtained from 5,492 physicians (21.9% women; aged 60.4; standard deviation, 12.1 years) with a response rate of 74.6%. Overall, 76.7% of the physicians had awareness of HTP, and about half of whom asked patients about using HTPs. Physicians who took longer to discuss cessation were more likely to discourage patient use. Smoking status was associated with discouraging HTP use in patients. Physicians who had experience with HTP use were primarily concerned about the products' long-term safety and less about product regulation. CONCLUSION Japanese physicians do not have sufficient information and knowledge about HTPs. Therefore, evidence-based guidelines are required to support physicians in advising patients against HTP use.
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Affiliation(s)
- Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
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Sharma A, Fix B, Hyland A, Quisenberry AJ, Bansal-Travers M, O'Connor RJ. Differences in demographics and behaviors across two web-based survey platforms: Observations from a study of risk perceptions of heated tobacco products (HTPs). Prev Med Rep 2023; 33:102194. [DOI: 10.1016/j.pmedr.2023.102194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
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Odani S, Tsuno K, Agaku IT, Tabuchi T. Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan. Tob Control 2023:tc-2022-057613. [PMID: 36849258 DOI: 10.1136/tc-2022-057613] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Heated tobacco products (HTPs) are often marketed as a safer alternative to help cigarette smokers quit. We investigated the link between HTP use and smoking cessation and relapse. METHODS 7044 adults (≥20 years old) with at least two observations over three waves (2019-2021) of a longitudinal, nationwide, internet-based survey were classified into current (past 30-day), former and never cigarette smokers. ≥1 month and ≥6 months smoking cessation and smoking relapse at 1-year follow-up were assessed in relation to current HTP use at baseline. Generalised estimating equation models were weighted to account for population differences between HTP users and non-users. Adjusted prevalence ratios (APRs) were computed within population subgroups. RESULTS At baseline, 17.2%, 9.1% and 6.1% of the respondents were current cigarette smokers, HTP users and dual users, respectively. Among current established smokers (having smoked regularly, n=1910), HTP use was significantly associated with a decreased likelihood of ≥1 month cessation within those who reported having used evidence-based cessation measures (APR=0.61), smoking 20+ cigarettes per day (APR=0.62), high school education or less (APR=0.73) and fair/poor health (APR=0.59). Negative associations were also seen for ≥6 months cessation among those aged 20-29 years (APR=0.56) and full-time workers (APR=0.56). Among former smokers (n=2906), HTP use was associated with smoking relapse within those who last smoked >1 year ago (APR=1.54), among women (APR=1.61), those aged 20-29 years (APR=2.09), those reporting high school education or less (APR=2.36), those who were unemployed/retired (AOR=3.31) and never/non-current alcohol users (APR=2.10). CONCLUSION HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.
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Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Israel T Agaku
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
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Kim S, Jo K. Multiple Tobacco Product Use among Adolescents with Asthma in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9633. [PMID: 35954989 PMCID: PMC9368394 DOI: 10.3390/ijerph19159633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 06/15/2023]
Abstract
Few studies have examined the use of multiple tobacco products among adolescents with asthma. The purpose of this study was to examine multiple tobacco product use and smoking behaviors. In this study, data from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) were used, and 57,303 samples from 400 middle schools and 400 high schools in Korea were classified as study participants. Statistical analysis was performed with a complex sample design, using frequency analysis, chi-square test, and multiple logistic regression analysis. Adolescents with asthma had a higher current smoking rate for combustible cigarettes (CC), e-cigarettes (EC), and heated tobacco products (HTPs) than those without asthma (p < 0.001). The rates of dual use (using two types of tobacco; CC + EC or CC + HTPs or EC + HTPs; OR = 2.62, 95% CI: 1.626−4.240, R2 = 26.8%) and triple use (using three types of tobacco; CC + EC + HTPs; OR = 2.61, 95% CI: 1.678−4.065, R2 = 34.9%) were higher in adolescents with asthma than those without asthma, after adjusting for confounders. The smoking rate of new types of tobacco among adolescents with asthma is on the rise. Therefore, the calculation of basic data related to new tobacco smoking among adolescents is essential for establishing a continuous monitoring system to alleviate the burden of disease on national health.
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Affiliation(s)
- Seokhwan Kim
- Department of Health Information, Dongguk University, Wise Campus, 123, Dongdae-ro, Gyeongju-si, Gyeongsangbuk-do 38066, Korea
| | - Kyuhee Jo
- College of Nursing, Korea University, Anam-Dong, Seongbuk-Gu, Seoul 02841, Korea
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Yamamoto S, Tanaka A, Ohmagari N, Yamaguchi K, Ishitsuka K, Morisaki N, Kojima M, Nishikimi A, Tokuda H, Inoue M, Tanaka S, Umezawa J, Okubo R, Nishimura K, Konishi M, Miyo K, Mizoue T. Use of heated tobacco products, moderate alcohol drinking, and anti-SARS-CoV-2 IgG antibody titers after BNT162b2 vaccination among Japanese healthcare workers. Prev Med 2022; 161:107123. [PMID: 35787841 PMCID: PMC9249408 DOI: 10.1016/j.ypmed.2022.107123] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/08/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022]
Abstract
The effect of heated tobacco products (HTPs) use and moderate alcohol drinking on immunogenicity to coronavirus disease (COVID-19) vaccines remain elusive. This study aimed to examine the association of tobacco product use and alcohol consumption with anti-SARS-CoV-2 spike IgG antibody titers after the BNT162b2 vaccine. Participants were 3433 healthcare workers receiving two vaccine doses in the 4 national centers for advanced medical and research in Japan. Smoking status and alcohol consumption were assessed via a questionnaire, and anti-SARS-CoV-2 spike IgG titers were measured with chemiluminescent enzyme immunoassay using serum collected on the median of 64 days after the second vaccination. Multilevel linear regression models were used to estimate the geometric mean titers (GMT) and the ratios of means (RoM) between groups with adjustment for covariates. Compared with never-smokers (GMT = 118), IgG antibody titers were significantly lower among HTPs users (including those who also smoked cigarettes) (GMT = 105; RoM = 0.89 [95%CI: 0.78-0.99]) and exclusive cigarettes smokers (GMT = 98; RoM = 0.81 [95%CI: 0.71-0.92]). Compared with non-drinkers of alcohol (GMT = 123), alcohol drinkers consuming <1 go/day (GMT = 113; RoM = 0.93 [95%CI: 0.88-0.98]), 1-1.9 go/day (GMT = 104; RoM = 0.85 [95%CI: 0.78-0.93]), and ≥ 2 go/day (GMT = 103; RoM = 0.84 [95%CI: 0.74-0.96]) had significantly lower antibody titers (P for trend<0.01). Spline analysis showed a large reduction of antibody until around 1 go/day of alcohol consumption, and then they gradually decreased. Results suggest that in addition to conventional cigarette smoking and heavy alcohol drinking, HTPs use and moderate alcohol drinking may be predictors of lower immunological response to COVID-19 vaccine.
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Affiliation(s)
- Shohei Yamamoto
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Akihito Tanaka
- Department of Laboratory Testing, Center Hospital of the National Center for the Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Koushi Yamaguchi
- Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kazue Ishitsuka
- Department of social science, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Naho Morisaki
- Department of social science, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Masayo Kojima
- Department of Frailty Research, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Akihiko Nishikimi
- Biosafety Division, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Haruhiko Tokuda
- Bioresource Division, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Manami Inoue
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan; Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shiori Tanaka
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Jun Umezawa
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Ryo Okubo
- Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Maki Konishi
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kengo Miyo
- Center for Medical Informatics Intelligence, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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10
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Hairi FM, Goh KT, Driezen P, Nordin ASA, Yee A, Tajuddin NAA, Hasan SI, Danaee M, Kamaludin IS, Kaai SC, Yan M, Grey M, Quah ACK, Thompson ME, Fong GT. Reasons for using e-cigarettes and support for e-cigarette regulations: Findings from the 2020 ITC Malaysia Survey. Tob Induc Dis 2022; 20:33. [PMID: 35431720 PMCID: PMC8969647 DOI: 10.18332/tid/146364] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Malaysia has the largest e-cigarette (EC) market in Southeast Asia, and it has been estimated that 17% of adult daily cigarette smokers also used ECs on a daily basis in 2020. However, few studies have examined the reasons people use ECs in Malaysia. This cross-sectional study of adult cigarette smokers from Malaysia assessed reasons for EC use and their support for key proposed EC regulations. METHODS Data are from the 2020 International Tobacco Control (ITC) Malaysia Wave 1 Survey of adult (aged ≥18 years) smokers who reported that they used ECs at least monthly (N=459 out of 1047 smokers). Weighted analyses were conducted on EC users' reasons for using ECs and their support for various EC regulations. RESULTS Smokers who used ECs at least monthly were more likely to be male, aged 25-39 years, of Malay ethnicity, married, more highly educated, and living in Peninsular Malaysia. Smokers who used ECs daily reported using ECs to reduce the number of cigarettes smoked (91.3%), pleasant taste (90.1%), to quit smoking (87.9%), and enjoyment (87.5%). Smokers who used ECs less than daily reported using ECs for their pleasant taste (weekly 89.4%, monthly 87.5%), curiosity (weekly 79.5%, monthly 88.8%), being offered EC by someone (weekly 76.3%, monthly 81.6%), and to reduce the number of cigarettes smoked (weekly 76.2%, monthly 77.6%). Smokers who also used ECs were most likely to support EC regulations requiring a minimum purchasing age (88.3%) and limiting nicotine concentration (79.6%), and least likely to support regulations banning EC fruit and candy flavors (27.1%). CONCLUSIONS The most prevalent reasons for using ECs in Malaysia are comparable to those of other ITC countries, including Canada, US, England, and Australia. An understanding of use patterns of ECs, especially their interaction with cigarettes, are important in developing evidence-based regulations in Malaysia.
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Affiliation(s)
- Farizah Mohd Hairi
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok Tiong Goh
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Yee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Amani Ahmad Tajuddin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Idayu Hasan
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ina Sharyn Kamaludin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan C. Kaai
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Matthew Grey
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Mary E. Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
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11
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Cruz-Jiménez L, Barrientos-Gutiérrez I, Zavala-Arciniega L, Arillo-Santillán E, Gallegos-Carrillo K, Rodríguez-Bolaños R, Gravely S, Thrasher JF. Heated tobacco product use, its correlates, and reasons for use among Mexican smokers. Drug Alcohol Depend 2022; 232:109283. [PMID: 35134734 PMCID: PMC9390091 DOI: 10.1016/j.drugalcdep.2022.109283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the use of novel heated tobacco products (HTPs) in low- and middle-income countries. We examined among smokers in Mexico the prevalence and correlates of HTP use, as well as reasons for using HTPs. METHODS We analyzed data from five surveys (November 2019-March 2021) of an open cohort of adult smokers (n = 6500), including an oversample of those who also use e-cigarettes. Mixed-effects multinomial logistic models were used to estimate associations between study variables and current HTP use or prior HTP trial relative to never trying HTPs. RESULTS The weighted prevalence of current HTP use was 1.1%. Independent correlates of current HTP use included smoking frequency, intention to quit, e-cigarette use, having partners/family-members who use e-cigarettes, friends who use HTPs, and exposure to HTP information inside/outside tobacco shops. Having partners/family members who smoke and not knowing about the harm of HTPs relative to cigarettes were associated with lower likelihood of current HTP use. Having tried HTPs was more likely among light daily smokers, those with family who use HTPs and exposure to HTP information outside shops and on newspapers/magazines. Among current users, the top reasons for using HTPs were greater social acceptability (50.6%) and lower perceived harm (34.9%) relative to cigarettes. CONCLUSIONS Uptake of HTPs appears relatively low among Mexican smokers, and correlates of use are similar to those for e-cigarette use. Further research is needed to determine if HTPs use promotes or impedes smoking cessation, given current HTP users are also likely to use various nicotine products.
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Affiliation(s)
- Lizeth Cruz-Jiménez
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Inti Barrientos-Gutiérrez
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Katia Gallegos-Carrillo
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Morelos, Mexico
| | | | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - James F Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA.
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12
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Inoue-Choi M, Freedman ND, Saito E, Tanaka S, Hirabayashi M, Sawada N, Tsugane S, Usui Y, Ito H, Wang C, Tamakoshi A, Takeuchi T, Kitamura Y, Utada M, Ozasa K, Sugawara Y, Tsuji I, Wada K, Nagata C, Shimazu T, Mizoue T, Matsuo K, Naito M, Tanaka K, Katanoda K, Inoue M. Low-intensity cigarette smoking and mortality risks: a pooled analysis of prospective cohort studies in Japan. Int J Epidemiol 2021; 51:1276-1290. [PMID: 34718588 DOI: 10.1093/ije/dyab224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/29/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Increasing proportions of smokers in Japan smoke <10 cigarettes per day (CPD). Yet, the health risks of low-intensity smoking in Asia are poorly understood. METHODS We performed a pooled analysis of 410 294 adults from nine population-based prospective cohort studies participating in the Japan Cohort Consortium. Cigarette-use data were collected at each study baseline in 1983-1994. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality were calculated using multivariable-adjusted Cox regression by CPD among current smokers and by age at cessation among former smokers, with never smokers as the referent group. Pooled HRs and CIs were computed using a random-effect model. RESULTS The smoking prevalence was 54.5% in men and 7.4% in women. About 15.5% of male and 50.4% of female current smokers smoked 1-10 CPD (low-intensity). Both male and female low-intensity smokers had higher all-cause mortality risks than never smokers. Risks were further higher with increasing CPD in a dose-response manner. HRs (95% CIs) were 1.27 (0.97-1.66), 1.45 (1.33-1.59) and 1.49 (1.38-1.62) for 1-2, 3-5 and 6-10 CPD, respectively, in men; 1.28 (1.01-1.62), 1.49 (1.34-1.66) and 1.68 (1.55-1.81) for 1-2, 3-5 and 6-10 CPD, respectively, in women. Similar associations were observed for smoking-related causes of death. Among former low-intensity smokers, younger age at cessation was associated with lower mortality risk. CONCLUSIONS Smoking very low amounts was associated with increased mortality risks in Japan. All smokers should quit, even if they smoke very few CPD.
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Affiliation(s)
- Maki Inoue-Choi
- Metabolic Epidemiology Branch, Division of Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Neal D Freedman
- Metabolic Epidemiology Branch, Division of Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eiko Saito
- Center for Cancer Control & Information Services, National Cancer Center, Tokyo, Japan
| | - Shiori Tanaka
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Mayo Hirabayashi
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yoshiaki Usui
- Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Hidemi Ito
- Division of Cancer Information and Control, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Chaochen Wang
- Department of Public Health, Aichi Medical University School of Medicine, Aichi, Japan
| | - Akiko Tamakoshi
- Department of Public Health, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Taro Takeuchi
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuri Kitamura
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mai Utada
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Kotaro Ozasa
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Yumi Sugawara
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiko Wada
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Taichi Shimazu
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Mariko Naito
- Department of Oral Epidemiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Keitaro Tanaka
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kota Katanoda
- Center for Cancer Control & Information Services, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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13
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Harada S, Sata M, Matsumoto M, Iida M, Takeuchi A, Kato S, Hirata A, Kuwabara K, Shibuki T, Ishibashi Y, Sugiyama D, Okamura T, Takebayashi T. Changes in smoking habits and behaviors following the introduction and spread of heated tobacco products in Japan and its effect on FEV 1 decline: a longitudinal cohort study. J Epidemiol 2021; 32:180-187. [PMID: 34657910 PMCID: PMC8918621 DOI: 10.2188/jea.je20210075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Heated tobacco product (HTP) use in Japan has rapidly increased. Despite this rapid spread, little is known about the health effects of HTP use. We conducted a longitudinal cohort study to investigate the change in smoking habits following the spread of HTP use and its effect on forced expiratory volume in 1 second (FEV1) decline. Methods Participants consisted of a resident population (n = 2,612; mean age, 67.7 years) with FEV1 measurement in 2012–2014 and 2018–2019, and a worksite population (n = 722; mean age 49.3 years) without FEV1 data. Participants were categorized as combustible cigarette-only smokers, HTP-only users, dual users, past smokers, and never smokers. The association between smoking group and the change in smoking consumption over a mean 5.6 years was examined. Differences in annual FEV1 change between smoking groups were examined in the resident population. Results Prevalence of HTP-only and dual users in 2018–2019 was 0.8% and 0.6% in the resident population, and 5.0% and 1.9% in the worksite population, respectively. The overall number of tobacco products smoked/used increased in dual users compared to baseline, but not in others. Annual FEV1 decline in dual users tended to be greater than that in cigarette-only smokers (16; 95% confidence interval, −34 to 2 mL/year after full adjustment). Participants switching to HTP-only use 1.7 years before had a similar FEV1 decline as cigarette-only smokers. Conclusions HTP use, including dual use, is prevalent even in a rural region of Japan. Dual users appear to smoke/use tobacco products more and have a greater FEV1 decline. Tobacco policy should consider dual use as high-risk.
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Affiliation(s)
- Sei Harada
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Mizuki Sata
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Minako Matsumoto
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Miho Iida
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Ayano Takeuchi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Suzuka Kato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Aya Hirata
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Kazuyo Kuwabara
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Takuma Shibuki
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Yoshiki Ishibashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Daisuke Sugiyama
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine
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14
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Li L, Borland R, Cummings KM, Gravely S, Quah ACK, Fong GT, Miller CR, Goniewicz ML, Le Grande M, McNeill A. Patterns of Non-Cigarette Tobacco and Nicotine Use Among Current Cigarette Smokers and Recent Quitters: Findings From the 2020 ITC Four Country Smoking and Vaping Survey. Nicotine Tob Res 2021; 23:1611-1616. [PMID: 33693833 PMCID: PMC8562420 DOI: 10.1093/ntr/ntab040] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/04/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION This study explores patterns of use of non-cigarette tobacco and nicotine products among adult cigarette smokers and recent ex-smokers. Along with cigarette smoking status we explore differences as a function of countries with different product regulations, gender, and age. METHODS Data came from the ITC Four Country Smoking and Vaping Wave 3 Survey conducted between February-June 2020. The analytic sample consisted of 9112 current cigarette smokers (at least monthly) and 1184 recent ex-smokers (quit cigarettes ≤ 2 years) from Australia, Canada, England, and the United States. Respondents were asked about their cigarette smoking and current use of the following non-cigarette products: combustible tobacco (cigars, cigarillos, pipe, waterpipe); noncombustible tobacco (smokeless tobacco, and heated tobacco products [HTPs]); and non-tobacco nicotine products (nicotine vaping products [NVPs], nicotine replacement therapy [NRT], and nicotine pouches). RESULTS Overall, NVPs (13.7%) and NRT (10.9%) were the most reported nicotine products used, followed by cigars (5.3%), cigarillos (4.2%), and HTPs (3.5%). More than 21% current and recent ex-smokers of cigarettes reported using a non-tobacco nicotine product and noncombustible product, with respondents in England reporting the highest levels of use (>26%). Males, younger respondents, and current non-daily cigarette smokers were more likely to use non-cigarette nicotine products. Notably, 11.6% of ex-cigarette smokers were using other combustible tobacco. CONCLUSION Considerable percentages of current cigarette smokers and ex-smokers use non-cigarette nicotine products, and there are unexpectedly high levels of use of other combustible products by those recent ex-smokers of cigarettes which is concerning and has important implications for definitions of smoking cessation. IMPLICATIONS The tobacco product market has evolved to include new products which add to existing non-cigarette tobacco products creating a much more diverse nicotine market. This brief report provides a snapshot of use of various combustible and noncombustible nicotine-containing products among current cigarette smokers and recent ex-smokers in four western countries. Our results indicate that use of non-cigarette tobacco and nicotine products among these cigarette smokers and recent ex-smokers is not low, particularly among males, younger and non-daily cigarette smokers. Use of other combustible tobacco among respondents that recently quit cigarette smoking is concerning and has important implications for definitions of smoking cessation. Increased emphasis on researching non-cigarette nicotine product use is warranted in tobacco control generally and smoking cessation in particular.
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Affiliation(s)
- Lin Li
- Melbourne Centre for Behaviour Change, School of Psychological
Sciences, University of Melbourne,
Melbourne, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological
Sciences, University of Melbourne,
Melbourne, Australia
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of
South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South
Carolina, Charleston, SC
| | - Shannon Gravely
- Department of Psychology, University of Waterloo,
Waterloo, ON, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo,
Waterloo, ON, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo,
Waterloo, ON, Canada
- School of Public Health and Health Systems, University of
Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research,
Toronto, ON, Canada
| | - Connor R Miller
- Department of Health Behavior, Roswell Park Comprehensive Cancer
Center, Buffalo, NY
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer
Center, Buffalo, NY
| | - Michael Le Grande
- Melbourne Centre for Behaviour Change, School of Psychological
Sciences, University of Melbourne,
Melbourne, Australia
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and
Neuroscience, King’s College London,
London, UK
- Shaping Public hEalth poliCies To Reduce ineqUalities and harm
(SPECTRUM), UK
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15
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Kim SH, Kang SY, Cho HJ. Beliefs about the Harmfulness of Heated Tobacco Products Compared with Combustible Cigarettes and Their Effectiveness for Smoking Cessation among Korean Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5591. [PMID: 32756449 PMCID: PMC7432154 DOI: 10.3390/ijerph17155591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/20/2020] [Accepted: 08/01/2020] [Indexed: 02/07/2023]
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.
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Affiliation(s)
- Seung Hee Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Seo Young Kang
- International Healthcare Center, Asan Medical Center, Seoul 05505, Korea;
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
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