Patterns of cigarette, heated tobacco product, and nicotine vaping product use among Korean adults: Findings from the 2020 ITC Korea Survey

Introduction Non-combustible nicotine products (NCNPs), such as heated tobacco products (HTPs) and nicotine vaping products (NVPs) have gained a significant nicotine market share in South Korea. This descriptive study examined patterns of regular cigarette and NCNP use among South Korean adults. Methods Data were from the 2020 International Tobacco Control Korea Survey and included 4016 adults (aged ≥19 years) in the Republic of Korea who were regularly (at least weekly) using at least one NCNP (NVP/HTP, n=2117) and/ or smoked cigarettes (n=3763) at the time of the survey. Weighted descriptive estimates were computed to assess respondents’ nicotine product use among all respondents (exclusive, dual, or triple use). Thereafter, we identified sociodemographic characteristics associated with NCNP use (n=2117). Results Among Korean adults who were smoking cigarettes, 83.1% (95% CI: 81.6– 84.6) did so exclusively, and 16.9% (95% CI: 15.4–18.4) smoked cigarettes and used NCNPs. Among those who used HTPs (n=1877), 14.9% (95% CI: 11.5–18.4) did so exclusively, 59.6% used HTPs and smoked cigarettes (95% CI: 55.4–63.1), 4.2% used HTPs and vaped (95% CI: 11.5–18.4), and 21.6 % (95% CI: 18.9–24.2) used all three products. Of adults who used HTPs and smoked cigarettes, 86.6% smoked daily. Among those who vaped (n=865), 13.3% did so exclusively (95% CI: 9.4–17.1), 55.6% (95% CI: 49.6–61.5) vaped and smoked cigarettes, 5.1% (95% CI: 1.7–8.6) used HTPs and vaped, and 26.1% (95% CI: 22.1–30.1) used all three products. Of adults who vaped and smoked cigarettes, 82.4% (95% CI: 77.1–87.7) smoked daily. Conclusions Cigarettes remain the most commonly used nicotine product in South Korea, and among adults using heated tobacco and/or vaping products, the majority were also smoking. Research is urgently needed to assess whether adults who are using an NCNP are doing so to quit, or rather to complement their cigarette smoking.