Heated Tobacco Products- Well Known or Well Understood? A National Cross-Sectional Study on Knowledge, Attitudes and Usage in Pakistan

Abstract

Abstract Background: Heated tobacco products (HTPs) are reshaping the tobacco industry and just recently, a plan was sought to regularize HTPs in Pakistan. Pakistan provides an intriguing case study in this context, as tobacco use is deeply ingrained in public use. To ensure that future evidence-based policy recommendations are grounded in the public's knowledge, attitudes, and usage of HTPs, a nationwide survey on the topic must be conducted. Methods: We conducted a nationwide web-based cross-sectional study in Pakistan to assess knowledge, attitudes, and usage of HTPs among adults (age ≥ 18). A questionnaire was created combining previous tobacco-based public questionnaires and was content validated through pulmonologists at AKU. Additionally, it was pilottested for face validity and internal consistency, consequentlyverified using Cronbach Alpha. Statistical analysis was performed using STATA 17. Results:In our sample of 1195 respondents with a mean age of 33.17±3.70 comprising of 41.8% males and 58.2% females from Pakistan, 54.7% had heard about HTPs before the survey and 16.9% reported using HTPs at least once. Additionally, 38.24% were unsure of the legality of HTP use. Those with monthly household incomes of PKR 100,000 to 500,000, were more likely to have higher knowledge scores (OR:1.80[1.07-3.04]). On the other hand, males (OR:0.70 [0.55-0.89]) and respondents from Balochistan (OR:0.40 [0.22-0.71]) had lesser odds of high knowledge scores. The strongest motivators were the enjoyability of HTPs (55.73%) and usage as a cigarette alternative (54.64%), while the strongest deterrents were the negative health effects (82.68%) and potential for addiction (81.01%). Conclusion: Our study underscores the need for awareness campaigns and interventions concerning HTPs, given prevalent preconceived notions and mixed attitudes among respondents. These insights form the basis for informed policy making for non-cigarette tobacco products.