Comparison of nicotine dependence between exclusive, dual, and triple tobacco users among Korean adults: A crosssectional study

초록

INTRODUCTION Since the introduction of electronic cigarettes (e-cigarettes, ECs) and heated-tobacco products (heat-not-burn tobacco products, HTPs), the patterns of tobacco product use have shifted from only combustible cigarette (CC) smoking to various combinations of these three products. This study aimed to compare nicotine dependence according to exclusive, dual, and triple use among Korean adults. METHODS This cross-sectional study used a self-reported online survey to investigate tobacco product use among Korean adults from 7 to 17 November 2022. Participants were recruited from members of an online panel via email invitations based on the 2022 Korean national population registration. Among 13288 respondents, 8000 participants (4000 men and 4000 women) were included in the final analysis. One time of EC use (approximately 15 puffs, lasting around 10 minutes) or one stick of HTP use is considered equivalent to one CC. Nicotine dependence was assessed by time-to-first tobacco use, total amount of use, and the Heaviness Index (HI). RESULTS The prevalence of CC only users, EC only users, and HTP only users were 13.4%, 1.6%, and 2.0%, respectively. Dual users of CCs + ECs, CCs + HTPs, and ECs + HTPs were 3.4%, 4.4%, and 0.7%, respectively. Triple users were 3.2%. Compared with CC only users, the adjusted odds ratios (AORs) (95% confidence interval, CI) for high HI were 5.52 (3.18-9.57) for CC+EC users, 5.40 (3.20-9.11) for CC+HTP users, and 4.98 (1.92-12.87) for EC+HTP users. The AOR (95% CI) for high HI was 10.95 (6.48-18.51) for triple users. CONCLUSIONS In this study, we found that dual or triple users tended to show higher nicotine dependence than CC only users. Further studies are needed to investigate whether dual or triple use of tobacco products leads to greater nicotine dependence.

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