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.