Reasons for Initiation and Regular Use of Heated Tobacco Products among Current and Former Smokers in South Korea: Findings from the 2020 ITC Korea Survey

Abstract

South Korea is the world’s second-largest heated tobacco product (HTP) market after Japan. HTP sales in South Korea have increased rapidly since May 2017, accounting for 10.6% of the total tobacco market in 2020. Despite this, little is known as to why HTP consumers who were current and former smokers started using HTPs and used them regularly. We analyzed cross-sectional data for 1815 adults (aged 19+) who participated in the 2020 International Tobacco Control (ITC) Korea Survey, of whom 1650 were HTP-cigarette consumers (those who reported smoking cigarettes and using HTPs ≥ weekly) and 165 were exclusive HTP consumers (using HTPs ≥ weekly) who were former or occasional smokers (smoking cigarette < weekly). Respondents were asked to report the reason(s) they used HTPs, with 25 possible reasons for HTP-cigarette consumers and 22 for exclusive HTP consumers. The most common reasons for initiating HTP use among all HTP consumers were out of curiosity (58.9%), family and friends use HTPs (45.5%), and they like the HTP technology (35.9%). The most common reasons for regularly using HTPs among all HTP consumers were that they were less smelly than cigarettes (71.3%), HTPs are less harmful to own health than cigarettes (48.6%), and stress reduction (47.4%). Overall, 35.4% of HTP-cigarette consumers reported using HTPs to quit smoking, 14.7% to reduce smoking but not to quit, and 49.7% for other reasons besides quitting or reducing smoking. In conclusion, several common reasons for initiating and regularly using HTPs were endorsed by all HTP consumers who were smoking, had quit smoking completely, or occasionally smoked. Notably, only about one-third of HTP-cigarette consumers said they were using HTPs to quit smoking, suggesting that most had no intention of using HTPs as an aid to quit smoking in South Korea.

Patterns of cigarette, heated tobacco product, and nicotine vaping product use among Korean adults: Findings from the 2020 ITC Korea Survey

“…The findings of this study are consistent with those of other studies indicating that Koreans are using HTPs to complement cigarette smoking 10 , 13 , 14 . Moreover, the high rate of daily smoking (>90%) suggests longitudinal studies are needed to examine whether people are using HTPs to help to quit their cigarette smoking or merely out of convenience (e.g.…”

“…A 2018–2019 Italian study found that triple product use accounted for 40% among those who used HTPs and 15% among those who vaped 24 . According to a study conducted by Seo et al 14 , there is no significant difference in motivations for initiating and regularly using HTPs (i.e. curiosity, reduced odor, perceived harm reduction compared to cigarettes) between individuals who used HTPs and smoked, and those who used all three products.…”

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis

“…Interplay of factors like personal circumstances (e.g., socioeconomic status, peer susceptibility, nicotine dependence), situational factors (e.g., peer use, product susceptibility) and person-product interaction (e.g., reinforcement, product knowledge, perceived harm) explain the initiation and continuation of multiple tobacco products among people [20]. Similar trends have been seen with alternative tobacco products like e-cigarettes and vaping pens [21][22][23][24]. These are often marketed as safer alternatives to the traditional products like cigarettes and smokeless tobacco products, that causes less harm [25,26] and thus, aid in cessation.…”

Heated tobacco product use frequency, smoking quit attempts, and smoking reduction among Mexican adult smokers

“…Similar associations have been found in the UK, where 67.7% of adult HTP users attributed their use to the influence of friends or family members 30 . Also, 45.5% of Korean adult current and former smokers reported initiating HTP use due to family and friends 31 . Social connections, particularly within close circles, play a pivotal role in adopting innovative products like HTPs.…”