Abstract
INTRODUCTIONThe relationship between nicotine dependence and the use of multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), is not well investigated. We evaluated nicotine dependence symptoms among South Korean adults among single and multiple tobacco product users.METHODSWe conducted an online survey involving 7000 adults aged 20–69 years in November 2018 and compared the nicotine dependence among single, dual, and triple use of tobacco products. Nicotine dependence was measured for ‘time to the first use of tobacco products within 5 min’, ‘awaking at night’, ‘strong craving’, ‘uncontrollable urge to smoke’, and ‘irritability or restlessness’. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for nicotine dependence symptoms based on the number of tobacco products were estimated using multivariable logistic regression analysis.RESULTSThe current prevalence of use of tobacco products was 27.5%. Proportion of dual and triple uses were: 28.3%, 13.7% for CCs; 36.5%, 50.2% for ECs; and 54.0%, 33.1% for HTPs. Nicotine dependence tended to be higher as the number of tobacco products used increased for most measures, except for ECs with the measure ‘time to first use of tobacco products within 5 min’. The ORs of ‘awaking at night’ increased approximately three times for dual users (OR=2.87; 95% CI: 1.29–6.39, for current EC users) and seven times for triple users (OR=7.24; 95% CI: 3.66–14.31, for current HTP users) compared to that for single users.CONCLUSIONSMultiple tobacco product users reported higher nicotine dependence symptoms than single users. High nicotine dependence of multiple tobacco product users may hamper the future cessation of tobacco products, which can be challenging for future tobacco control policies in South Korea.
Highlights
The relationship between nicotine dependence and the use of multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), is not well investigated
We found that the nicotine dependence measurement used in our study can be applied to users of HTP and EC in addition to CC smokers
Our study found that the prevalence of dualand triple-product users among current EC and HTP users was high, and nicotine dependence symptoms were higher in multiple tobacco product type users than in single tobacco product users
Summary
The relationship between nicotine dependence and the use of multiple tobacco products, such as heated tobacco products (HTPs), electronic cigarettes (ECs), and combustible cigarettes (CCs), is not well investigated. We evaluated nicotine dependence symptoms among South Korean adults among single and multiple tobacco product users. In Korea, the adult smoking prevalence decreased from 35.2% in 1998 to 20.2% in 20192. The number of Korean adults who use electronic cigarettes (ECs) has consistently increased from 2.3% in 2016 to 3.3% in 2019 since e-cigarette (EC) introduction to the Korean market in. Heated tobacco products (HTPs) are fast expanding their market share in South Korea. HTPs have successfully assimilated in the market and increased interest among smokers since IQOS by Philip Morris International, a leading HTP brand, was launched in South Korea in July 2017. HTPs accounted for 2.2% of total tobacco sales in the first year of their launch, and the prevalence of HTP use in the last month among adults was 5.1% in 20192,3
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