Korean J Fam Med Search


Korean J Fam Med > Volume 44(3); 2023 > Article
Cho: Is Using Heated Tobacco Products Helpful in Smoking Cessation?
New tobacco products, including electronic cigarettes (ECs) and heated tobacco products (HTPs), have been introduced into the market since tobacco control policies have been strengthened [1]. The tobacco industry has promoted HTPs, claiming that they are less harmful and helpful in smoking cessation [2]. However, the health risks of HTPs and their effects on smoking cessation have not been determined.
The perceived harm of tobacco products plays an important role in determining the decision to quit smoking. The belief that HTPs are less harmful and healthier alternatives to conventional cigarettes (CCs) can result in their continued use [3]. The tobacco industry markets HTPs as tobacco products with reduced exposure to toxic chemicals. However, reduced exposure does not inherently reduce health risks. Furthermore, it has been reported that HTPs produce toxic substances that are not found in CCs [4]. Nonetheless, some individuals may misunderstand HTPs as safe tobacco products with reduced health risks. Kim et al. [5] reported that only 16.8% of Korean adults believe that HTPs are less harmful than CCs. The negative perception of HTPs among Korean adults can be attributed to relatively stringent tobacco regulations in Korea. In their study, HTP users were more likely to perceive HTPs as less harmful than CCs compared to CC-only users. In addition, triple users had the highest odds of perceiving HTPs as less harmful than CCs. These findings suggest that a lower perceived harm to HTPs may contribute to the use of multiple tobacco products.
In the present issue, Won et al. [6] compared the intention to quit smoking within 6 months and quitting attempts in the past year among CC-only smokers, HTP-only smokers, and dual users of CCs and HTPs, using data from the eighth Korea National Health and Nutrition Examination Survey (KNHANES VIII-1), 2019. The study participants included 947 adults who smoked CCs or HTPs daily. In their study, HTP-only smokers were less likely to have the intention to quit smoking (odds ratio [OR], 0.398; 95% confidence interval [CI], 0.195–0.813) and past quitting attempts (OR, 0.533; 95% CI, 0.298–0.954) compared to CC-only smokers. However, there was no significant difference in smoking cessation behaviors between dual users and CConly smokers. These findings suggest that using HTPs may hinder smoking cessation rather than help it.
Kalkhoran and Glantz [7] conducted a meta-analysis to assess the association between EC use and smoking cessation. They reported that smoking cessation was 28% lower in EC users than in those who did not use ECs [7]. This contrasts with claims by the tobacco industry that ECs could be helpful in smoking cessation. Unlike in clinical settings, ECs can be purchased freely and consumed for recreational purposes in the real world. Therefore, rather than being used as smoking cessation aids, ECs may be used to circumvent smoking control policies. We do not believe that the association between HTP use and smoking cessation differs from that between EC use and smoking cessation. Therefore, we believe that HTP use is associated with reduced smoking cessation in the real world.
Since HTPs were launched in Korea in 2017, their sales have grown rapidly, accounting for approximately 10% of the total tobacco market in a year. Simultaneously, the decline in total cigarette sales has slowed, the current smoking rate among adolescents and female adults has plateaued or increased, and the number of visitors to smoking cessation clinics has decreased [8]. Do you think that using HTPs is helpful in smoking cessation, as claimed by the tobacco industry? I do not think so.



No potential conflict of interest relevant to this article was reported.


1. Lee S, Kim J. Evolution of tobacco products. J Korean Med Assoc 2020;63:88-95.
crossref pdf
2. Lee C, Kim S, Cheong YS. Issues of new types of tobacco (e-cigarette and heat-not-burn tobacco): from the perspective of ‘tobacco harm reduction’. J Korean Med Assoc 2018;61:181-90.
crossref pdf
3. Sparrock LS, Phan L, Chen-Sankey J, Hacker K, Ajith A, Jewett B, et al. Heated tobacco products: awareness, beliefs, use and susceptibility among US adult current tobacco users, 2021. Int J Environ Res Public Health 2023;20:2016.
crossref pmid pmc
4. St Helen G, Jacob Iii P, Nardone N, Benowitz NL. IQOS: examination of Philip Morris International’s claim of reduced exposure. Tob Control 2018;27(Suppl 1):s30-6.
crossref pmid
5. Kim SH, Kang SY, Cho HJ. Beliefs about the harmfulness of heated tobacco products compared with combustible cigarettes and their effectiveness for smoking cessation among Korean adults. Int J Environ Res Public Health 2020;17:5591.
crossref pmid pmc
6. Won D, Jung W, Shin D. Comparison of the smoking cessation of heated tobacco product users and conventional cigarette smokers in Korea. Korean J Fam Med 2023;44:151-7.
crossref pmid pmc pdf
7. Kalkhoran S, Glantz SA. E-cigarettes and smoking cessation in realworld and clinical settings: a systematic review and meta-analysis. Lancet Respir Med 2016;4:116-28.
crossref pmid pmc
8. Lee CM. The impact of heated tobacco products on smoking cessation, tobacco use, and tobacco sales in South Korea. Korean J Fam Med 2020;41:273-81.
crossref pmid pmc pdf


Browse all articles >

Editorial Office
Room 2003, Gwanghwamun Officia, 92 Saemunan-ro, Jongno-gu, Seoul 03186, Korea
Tel: +82-2-3210-1537    Tax: +82-2-3210-1538    E-mail: kjfm@kafm.or.kr                

Copyright © 2024 by Korean Academy of Family Medicine.

Developed in M2PI

Close layer
prev next