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Original research
Use of heated tobacco products where their use is prohibited
  1. Jung Ah Lee1,
  2. Cheolmin Lee2,
  3. Hong-Jun Cho3
  1. 1 Total Health Care Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
  2. 2 Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
  3. 3 Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Professor Hong-Jun Cho, Department of Family Medicine, Asan Medical Center, Songpa-gu, Korea (the Republic of); hjcho{at}amc.seoul.kr

Abstract

Introduction Stealth use implies using tobacco products where their use is prohibited. This paper aimed to investigate stealth use of heated tobacco products (HTPs) in terms of its prevalence and associated factors.

Methods An online survey was conducted to investigate the use of HTPs in 7000 randomly selected participants (2300 men and 4700 women, aged 20–69 years) from the database registered with an online-research company; we used a sex ratio of 1:2, considering a low female prevalence of tobacco use in Korea. Of total participants, 574 (8.2%) were current HTP users. Among them, we identified the participants who had practised HTPs stealth use, and evaluated associated factors using multivariable Poisson regression.

Results A total of 574 participants were identified as current HTP users, and 455 (79.2%) reported stealth use of HTPs during the month before the survey. Stealth use was more frequent in dual cigarette users (HTPs and electronic cigarettes (ECs); adjusted prevalence ratio (aPR) 1.33, 95% CI 1.16 to 1.52) and triple users (HTPs, ECs and combustible cigarettes; aPR 1.18, 95% CI 1.04 to 1.33), as compared with single-HTP users. Stealth use was more prevalent among participants who agreed with allowing indoor HTP use (aPR 1.18, 95% CI 1.11 to 1.26).

Conclusion Stealth use was prevalent among current HTP users, especially among the poly-users of tobacco products. Considering the positive relationship between an agreement with allowing indoor use of HTPs and stealth use, a campaign to promote change in attitudes of HTP users about their indoor use may be warranted to protect non-users.

  • electronic nicotine delivery devices
  • nicotine
  • co-substance use

Data availability statement

Data are available upon reasonable request. The authors are willing to provide the anonymised data related to this work upon reasonable request.

https://doi.org/10.1136/tobaccocontrol-2020-056398

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    Data availability statement

    Data are available upon reasonable request. The authors are willing to provide the anonymised data related to this work upon reasonable request.

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    Footnotes

    • Contributors JA Lee performed data analysis, interpreted the results, drafted and revised the manuscript. C Lee critically reviewed and edited the manuscript. HJ Cho designed the study, interpreted the results, critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

    • Funding This study was supported by the Korea Ministry of Health and Welfare (11-1352000-002406-01).

    • Competing interests There are no competing interests.

    • Provenance and peer review Not commissioned; externally peer reviewed.