Comparing identity, attitudes, and indicators of effectiveness in people who smoke, vape or use heated tobacco products: a cross-sectional study

Background: There is limited long-term and independent research on heated tobacco products (HTPs). We compared people who used HTPs with those who used nicotine vaping products (NVP) or cigarettes on smoker identity, indicators of effectiveness and, among NVP/HTP users, perceptions of these products. Methods: Adults exclusive cigarette smokers (N=45) and ex-smokers with medium/long-term (>3months) NVP (N=46) or HTP use (N=45) were recruited in London, UK. Participants completed a questionnaire assessing socio-demographics, smoking characteristics, smoker identity, dependence, intention to stop and attitudes towards HTP/NVP. Results: In adjusted analysis, people who used cigarettes (Mean Difference (MD)=1.4, 95%Confidence Intervals (CI) 0.7,2.0) and HTPs (MD=0.8, 95%CI 0.1,1.5) reported stronger smoker identities than those who used NVPs. Compared with smokers, HTP/NVP users had lower cravings for cigarettes (MD=3.0, 95%CI 1.6,4.3; MD=3.1, 95%CI 1.9,4.3, respectively), and higher intention to stop product use (MD=-0.8, 95%CI -1.7,-0.01; MD=-1.2, 95%CI -2.0,-0.3, respectively). People using HTPs or NVPs reported similar perceived product satisfaction (HTP:M=3.4, 95%CI 2.8,3.9; NVP:M=3.0, 95%CI 2.5,3.5), efficacy for smoking cessation (HTP:M=4.5, 95%CI 4.2,4.9; NVP:M=4.6, 95%CI 4.3,4.9) and safety (HTP:M=2.1, 95%CI 2.0,2.2; NVP:M=2.0, 95%CI 1.8,2.1). HTP users reported greater perceived addictiveness than NVPs (MD=0.3, 95%CI 0.2,0.6). Conclusions: HTP and NVP users perceived products to be similarly acceptable and effective suggesting that HTPs, like NVPs, may support smoking cessation. However, since HTP use appears to maintain a stronger smoker identity and perceived addiction, this may suggest a more limited role of HTP for a permanent transition away from cigarettes.