Purpose Although heated tobacco product (HTP) use among adolescents is an emerging public health problem, little is known about the frequency and quantity of HTP use. Thus, we investigated the associations between the frequency and quantity of HTP use and smoking characteristics (i.e., combustible cigarette [CC] and electronic cigarette [EC] use, and attempts to quit smoking) among CC-smoking adolescents. Methods We analyzed nationally representative data from 2,470 Korean adolescents who were current CC smokers. To investigate our aim, we conducted multinomial logistic and logistic regression analyses. Results We found that daily and heavier CC users had greater likelihoods of more frequent and heavier HTP use. In addition, dual users of CCs and ECs were more likely to use HTPs more frequently and heavily than CC users who did not use ECs. Moreover, daily EC users had the highest risk of frequent and heavy HTP use. The frequency and quantity of HTP use were not associated with attempts to quit smoking. Compared to CC-only use, dual use of CCs and HTPs was not associated with quitting attempts, and triple use of CCs, ECs, and HTPs was associated with a lower likelihood of quitting attempts. Conclusion HTP use was less likely to displace CC use and promote attempts to quit smoking. Thus, strict regulations are required to prevent the promotion of HTPs as a substitute for CCs or as a means of quitting smoking. Additionally, health professionals should consider preventive interventions for HTP, as well as CC and EC use among adolescents.
Purpose This study aimed to understand the relationship between cigarette and electronic cigarette (e-cigarette) use and sleep health among Korean adolescents. Methods Using the 14th Korea Youth Risk Behavior Survey, we included 52,928 adolescents who responded to sleep satisfaction and sleep duration. Participants were classified into four groups: non-users, cigarette-only users, e-cigarette-only users, and dual users of both products. To examine the associations between cigarette and e-cigarette use and sleep health, data were analyzed using complex samples cross tabulation and complex samples logistic regression. Results Of the four groups, dual users reported the lowest level of sleep satisfaction and sleep duration; 57.0% and 86.9% of dual users were not satisfied with their sleep and have insufficient sleep duration, respectively. The proportion of students who were not satisfied with their sleep was higher among cigarette-only users compared to e-cigarette-only users (52.7% vs. 45.8%), but the two groups reported similar rates of insufficient sleep duration (84.2% vs. 84.3%). Compared to non-users, cigarette-only users, e-cigarette-only users, and dual users were more likely to not be satisfied with sleep (odds ratios [ORs] were 1.49, 1.36, and 1.75, respectively) and had significantly higher odds of experiencing insufficient sleep duration (ORs were 1.85, 2.06, and 2.34, respectively). Conclusion E-cigarette-only use and dual use as well as cigarette-only use were associated with poor sleep health. Therefore, to improve adolescent sleep health, health professionals should provide sleep intervention strategies considering the association between smoking and sleep health.