Perceptions of harmfulness of heated tobacco and nicotine vaping products compared to cigarettes, and the association of advertising exposure on harm perceptions among adults who smoke in South Korea: Cross-sectional findings from the 2020 ITC Korea Survey

Michelle R Goulette; Shannon Gravely; Steve S Xu; Gang Meng; Anne C K Quah; Sungkyu Lee; Sung-Il Cho; Yeol Kim; Sujin Lim; Maansi Bansal-Travers; Andrew Hyland; Geoffrey T Fong; Hong G Seo

doi:10.18332/tid/170252

Perceptions of harmfulness of heated tobacco and nicotine vaping products compared to cigarettes, and the association of advertising exposure on harm perceptions among adults who smoke in South Korea: Cross-sectional findings from the 2020 ITC Korea Survey

Tob Induc Dis. 2023 Sep 28:21:121. doi: 10.18332/tid/170252. eCollection 2023.

Authors

Michelle R Goulette¹, Shannon Gravely², Steve S Xu², Gang Meng², Anne C K Quah², Sungkyu Lee³, Sung-Il Cho⁴, Yeol Kim⁵, Sujin Lim⁶, Maansi Bansal-Travers¹, Andrew Hyland¹, Geoffrey T Fong^{2

7

8}, Hong G Seo⁵

Affiliations

¹ Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States.
² Department of Psychology, University of Waterloo, Waterloo, Canada.
³ Korea Center for Tobacco Control Research and Education, Seoul, Republic of Korea.
⁴ Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
⁵ Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Republic of Korea.
⁶ National Tobacco Control Center, Korean Health Promotion Institute, Seoul, Republic of Korea.
⁷ School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
⁸ Ontario Institute for Cancer Research, Toronto, Canada.

Abstract

Introduction: Heated tobacco products (HTPs) and nicotine vaping products (NVPs) both are legal consumer products in the Republic of Korea. Little is known about perceptions of harmfulness of HTPs and NVPs relative to cigarettes in South Korea among adults who smoke, and how exposure to marketing may be associated with harmfulness perceptions.

Methods: This study used data from the 2020 International Tobacco Control (ITC) Korea Survey, and included 3713 adult (aged 19 years) cigarette smokers who were: 1) exclusive smokers (n=1845); 2) dual HTP + cigarette consumers (n=1130); 3) dual NVP + cigarette consumers (n=224); and 4) triple consumers (all three products, n=514). Weighted multinomial regression models were conducted to estimate smokers' perceptions of harmfulness of HTPs and NVPs compared to cigarettes, NVPs to HTPs, and self-reported exposure to HTP/NVP advertising. Analyses compared the perceptions of harmfulness between the four different consumer groups, and tested whether exposure to HTP/NVP advertising was associated with perceptions of lower relative harm.

Results: Among all respondents, 27.5% believe that HTPs are less harmful than cigarettes and 23.4% believe that NVPs are less harmful than cigarettes. Exclusive cigarettes smokers were significantly less likely to perceive that HTPs and NVPs are less harmful than cigarettes compared to dual HTP + cigarette consumers, dual NVP + cigarette consumers, and triple consumers (all p<0.001). Half of respondents perceive NVPs as equally harmful as HTPs (14.1% perceive NVPs as more harmful than HTPs). Exposure to HTP/NVP advertising was associated with perceiving these products as less harmful than cigarettes.

Conclusions: About one-quarter of Korean cigarette smokers perceive HTPs and NVPs as less harmful than cigarettes. Further investigation is required to understand how harm perceptions and HTP/NVP advertising are related to changes in product use, such as switching between products, using multiple products, or discontinuing all product use.

Keywords: cigarettes; harmfulness; heated tobacco products; nicotine vaping products; perceptions; tobacco.