Use of heated tobacco products in Hong Kong current smokers was associated with lower motivation and greater perceived difficulties to quit cigarette smoking

Abstract

Background: Heated tobacco products (HTP) are widely promoted as a smoking cessation aid without sound evidence. We investigated the associations of HTP use with quitting related characteristics in Chinese adult smokers in Hong Kong. Methods: Current smokers (N=1712, 83.7% male, 46.8% aged ≥ 50 years) were interviewed through landline random digit dialing from February to September in 2018. Their use of HTP was categorized as current (used in the past 30 days), past (used before the past 30 days) vs. never. Smokers who planned to quit cigarette smoking within 30 days were regarded as ready to quit smoking (vs. not ready) and their quit attempts (abstinence for 24 hours or more) in the past 12 months were recorded (yes vs. no). Their motivation to quit cigarette smoking were measured by their perceived importance and confidence of quitting on a scale of 0-10 (higher score indicating stronger perceptions) and perceived difficulties were assessed in a similar way. Socio-demographic characteristics were also recorded. Descriptive statistics were weighted by the age and sex distribution of current smokers in Hong Kong. Multiple linear and logistic regressions yielded adjusted beta-coefficient (Beta) and odds ratios (AORs) of quitting related characteristics in relation to HTP use, adjusting for age, education, employment and monthly household income. Results: Over 1/10 current smokers were past HTP users (12.5%, 95% CI 10.7% to 14.5%) and 6.4% (5.1% to 8.1%) were current users. Past and current HTP use were not associated with readiness to quit or quit attempt (all P > 0.05). Past HTP users had less confidence in quitting (Beta -2.45, 95% CI -3.50 to -1.40) and perceived quitting as less important (-1.43, -2.52 to -0.34) and more difficult (1.77, 0.34 to 3.19). Stronger associations were found for current HTP users (confidence: -3.22, -4.60- to -1.83; difficulties: 2.65, 0.77 to 4.53). Conclusions: HTP users were not more ready to quit or try quitting cigarette smoking but had lower confidence and greater perceived difficulties of quitting. Our results suggest that HTP use may not help quitting but may reduce smokers’ motivation to quit. Prospective studies are warranted.