Heat-not-burn tobacco use and its associated factors in Chinese adults: a population-based survey in Hong Kong, China

Abstract

Background We investigated Heat-not-Burn (HnB) use and associated factors in Chinese adults in Hong Kong where HnB is not formally marketed. Methods A population-based landline telephone survey in 2017 collected information on awareness, intention to use, ever use of HnB, cigarette smoking status, ever electronic cigarettes (EC) use and sociodemographic characteristics in 5131 (45.2% male; 26.7% aged≥60) adults, and readiness to quit and Heaviness of Smoking Index (HSI) in 1704 (of 5131) current smokers. Descriptive statistics were weighted by the age, sex and smoking status of the Hong Kong adult population. Sociodemographics were mutually adjusted in logistic regression to yield adjusted odds ratios (AORs) for awareness, intention to use and ever use of HnB, adjusting for smoking status in all respondents. In current smokers, AORs for ever HnB use in relation to HSI, readiness to quit and ever EC use were calculated, adjusting for education, employment, and monthly household income. Results Overall, 11.3% (95%CI 10.0-12.7%) were aware of HnB and 1.0% (0.8-1.2%) had ever used it. Awareness was associated with being aged 40-49 (AOR 1.37, 95% CI 1.01-1.87) or 30-39 years (1.65, 1.13-2.43) (vs aged≥60), born in Hong Kong (1.37, 1.11-1.68), and higher monthly household income (P for trend 0.001). Ever HnB users had higher education level (P for trend 0.009), monthly household income (P for trend 0.003) and more were aged 30-39 years (AOR 3.80, 1.49-9.71), economically active (2.24, 1.08-4.62). In never HnB users, 7.3% (4.9-10.8%) intended to use HnB and they had higher education level (P for trend 0.02). More current (vs never) smokers were aware of HnB (AOR 2.91, 2.27-3.73) and intended to use HnB (21.29, 5.85-77.47), and had ever used HnB (126.49, 17.29-925.24). Ever HnB use in current smokers (8.9%) was associated with being more ready to quit (P for trend 0.05) and ever EC use (AOR 5.94, 3.74-9.43). Discussion Higher socioeconomic status was associated with intention to use and ever use of HnB. Cigarette smokers who were more ready to quit or had ever used EC were more likely to have used HnB. Funding The survey was funded by the Hong Kong Council on Smoking and Health.