Awareness and Use of Heated Tobacco Products among Youth Smokers in Hong Kong: A Cross-Sectional Study.

Laurie Long Kwan Ho,Wei Xia,Tai Hing Lam,William Ho Cheung Li,Ankie Tan Cheung

doi:10.3390/ijerph17228575

Abstract

The growing popularity of heated tobacco products (HTPs) among youth may act as a gateway for smoking and jeopardize youth health. We aimed to describe the use of HTPs among youth smokers in Hong Kong and examine their risk awareness of HTPs as well as awareness of the proposed legislation. We conducted retrospective data analyses on the Youth Quitline Cohort (n = 731). We extracted participants’ sociodemographic data, smoking profiles, and HTP use from 1 January 2017. Participants’ HTP use increased from 5.7% in 2017 to 37.9% in 2020. Among the 731 participants, 175 were HTP users and 556 were HTP nonusers. Compared with nonusers, a significantly higher proportion of HTP users had tried using other tobacco products at least once. The most common reason for using HTPs was curiosity. HTP users were more likely than nonusers to misclassify HTPs as e-cigarettes; agree that HTPs were healthier and contained fewer harmful substances than conventional cigarettes; consider HTPs as a smoking cessation aid; and believe that HTPs could reduce conventional cigarette consumption. Overall, 61.2% of youth smokers disagreed with banning HTPs. Risk awareness of HTPs among youth might affect their likelihood of using these products. Stricter regulations on advertising and intensive health education are imperative to avoid misleading information and limit youth exposure to such harmful products.

Highlights

The increasing use of alternative tobacco products among youth has offset the overall decrease in conventional cigarette use and become a global public health concern [1,2]
We asked participants to respond to the statements regarding their risk awareness of heated tobacco products (HTPs) as well as awareness of the proposed legislation, for instance, “Do you agree that HTPs such as IQOS is a type of e-cigarette or equivalent to e-cigarettes?” For HTP users, we examined their reasons for using such products
Our findings showed that most HTP users were dual users, which might contradict the claims supported by the Food andDrug Administration (FDA) that completely substituting HTPs for combusted cigarettes can reduce body exposure to harmful chemicals [11]

Summary

Introduction

The increasing use of alternative tobacco products among youth has offset the overall decrease in conventional cigarette use and become a global public health concern [1,2]. Spurred by increasing evidence unmasking the detrimental health effects of e-cigarettes, including undermining abstinence [3], encouraging dual use with increased toxicant exposures [4,5], and acting as a gateway for youth smoking [6], many countries and regions have enacted legislation regulating or completely banning such products [7,8]. Despite the fact that the health effects remain controversial, HTPs have been aggressively promoted and marketed as a safer alternative to conventional cigarettes because they generate a nicotine containing aerosol by heating tobacco at a lower temperature than combusted cigarettes [10].

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Discussion

Conclusion