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Association of heated tobacco product use with smoking cessation in Chinese cigarette smokers in Hong Kong: a prospective study
  1. Tzu Tsun Luk1,
  2. Xue Weng1,
  3. Yongda Socrates Wu1,
  4. Hiu Laam Chan1,
  5. Ching Yin Lau1,
  6. Anthony Cho-shing Kwong2,
  7. Vienna Wai-yin Lai2,
  8. Tai Hing Lam3,
  9. Man Ping Wang1
  1. 1School of Nursing, The University of Hong Kong, Hong Kong, China
  2. 2Hong Kong Council on Smoking and Health, Hong Kong, China
  3. 3School of Public Health, The University of Hong Kong, Hong Kong, China
  1. Correspondence to Dr Man Ping Wang, School of Nursing, University of Hong Kong, Hong Kong 999077, China; mpwang{at}


Introduction Heated tobacco products (HTPs) are increasingly popular worldwide, but whether they aid or undermine cigarette abstinence remains uncertain. We examined the predictors of HTP initiation and the prospective association of HTP use with cigarette abstinence in community-based smokers in Hong Kong.

Design Secondary analysis of a randomised clinical trial aimed to evaluate the effectiveness of brief advice and referral for smoking cessation. The interventions were not related to HTP use.

Participants and settings 1213 carbon monoxide-verified daily cigarette smokers with intentions to quit or reduce smoking proactively recruited from community sites throughout Hong Kong

Main exposure Current (past 7 day) use of HTP at baseline.

Main outcome Self-reported 7-day point-prevalence cigarette abstinence at 6 months (exclusive use of HTP permitted).

Results At baseline, 201 (16.6%) and 60 (4.9%) were ever and current HTP users, respectively. During the 6-month follow-up period, 110 of 1012 (10.9%) never users at baseline initiated HTPs. Younger age and higher education significantly predicted initiation. After adjusting for sociodemographic, smoking-related and quitting-related factors, current HTP use at baseline was not associated with cigarette abstinence at 6 months (adjusted prevalence ratio (aPR) 1.08, 95% CI 0.63 to 1.85). The results were similar in persistent users from baseline to 1-month/3-month follow-up (vs non-users; aPR 1.14, 95% CI 0.57 to 2.29). Use of smoking cessation service between baseline and 3-month follow-up significantly predicted cigarette abstinence (aPR 1.70, 95% CI 1.26 to 2.30).

Conclusion HTP use was not associated with cigarette abstinence at 6 months in a community-based cohort of smokers with intentions to quit or reduce smoking.

Trial registration details, NCT03565796.

  • harm reduction
  • cessation
  • non-cigarette tobacco products

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  • Twitter @TT_Luk, @KelvinW95143430

  • Contributors MPW obtained the funding and was the principal investigator of the study. TTL, XW, YSW, THL and MPW conceived the study. XW and CYL implemented the study. TTL conducted statistical analyses and drafted the first version of the manuscript. All authors reviewed the manuscript, interpreted the data and approved the final version of the manuscript.

  • Funding The study was supported by the Hong Kong Council on Smoking and Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 18-318).

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

  • Data availability statement The study protocol and de-identified individual participant data generated during this study are available from the investigators on reasonable request. Requests should be directed to the corresponding author by email.

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