Perception and use of new tobacco products among youths and adults in Hong Kong

Abstract

Background: New tobacco products, e.g. electronic cigarettes (EC) and heated tobacco products (HTP), are promoted as less harmful substitutes to conventional cigarettes (CC) without sound evidence. How the promotion may affect the use and perception of EC and HTP is not fully clear. Perception of tobacco products may also affect public support for tobacco control (TC) policies. More evidence is also needed on EC’s prospective effects on smoking cessation in Chinese smokers.

Objectives: To investigate (1) awareness and use of HTP, and intention to use this product in Hong Kong (HK) and associated factors, (2) EC’s prospective effects on quitting CC, (3) perception of EC and support for endgame policies on CC, (4) perception and experience of adult HTP users and youth EC users, (5) the role of social media on facilitating HTP use in HK.

Methods: A population-based landline survey was conducted in 2015, including 1706 never smokers, 1712 ex-smokers, and 1834 current smokers (total 5252 respondents). A similar survey in 2017 interviewed 5131 respondents (1712 never smokers, 1715 ex-smokers, and 1704 current smokers). Socio-demographic characteristics, smoking, and quitting-related characteristics, perception of EC were recorded and analyzed using logistic regressions in relation to outcomes on HTP and support for endgame policies. Two prospective studies in adult (n=956) and youth (n=189) smokers in 2014-15 measured ever EC use at baseline and recorded cessation outcomes at the 6-month follow-up. The prospective association was analyzed using logistic regressions. Adult HTP users (n=22) and youth EC users (n=4) were individually interviewed to collect data on their perception and experience, which were analyzed using thematic analysis. An infodemiology study using content analysis was conducted to explore the role of Facebook pages in facilitating HTP use in HK by analyzing the attributes of the pages.

Results: Awareness of HTP was associated with a younger age and born in HK. Ever HTP use was rare but more prevalent in people in higher education, more income and being current smokers. Ever HTP use and intention to use in never HTP users were more common in ever EC users. Ever EC users had similar self-reported past 7-day abstinence and quit attempt rates in both adult and youth smokers. Positive perception of EC was associated with less support for endgame policies on CC, including individual policy items and total ban on sale and use. Adult HTP users found HTP could help sustain their smoking and believed it is not a gateway to smoking. Youth EC users worried about the safety of EC and perceived it not helpful for quitting. Illicit tobacco sticks were sold on Facebook pages in a private manner.

Conclusions: This study found HTP users were in a higher socioeconomic status. The results supported EC use may not help quitting in a real-world setting. The promotion with health claims may foster positive perceptions of EC and HTP, subsequently may undermine tobacco control. Continuous surveillance is warranted to monitor the development and spread of these products. Effective public health actions should be implemented to provide the correct information.