# Socioeconomic status and its limited influence on perceptions of heated tobacco products and cigarettes: no relation with physical health, but association with mental health benefits and lower sensitivity to peer pressure

## TL;DR

This study finds that socioeconomic status does not affect how people view the physical health effects of heated tobacco products or cigarettes, but it does influence mental health perceptions and sensitivity to peer pressure.

## Contribution

The study reveals a novel link between low socioeconomic status and positive mental health perceptions of heated tobacco products.

## Key findings

- Socioeconomic status is not associated with perceptions of physical health impacts of heated tobacco products or cigarettes.
- Low socioeconomic status individuals are more likely to perceive mental health benefits from heated tobacco products.
- Women with low socioeconomic status show reduced sensitivity to peer pressure regarding smoking and heated tobacco use.

## Abstract

Socioeconomic status is related with individuals’ attitudes toward health behaviors and perceptions of risk. This study investigated the relationships between socioeconomic status and perceptions of the impact of heated tobacco products (HTPs) and cigarette smoking on the physical, mental, and social well-being of users.

A cross-sectional study was conducted using a population-based random sample of 2,500 HTP users and former smokers over the age of 25. The computer-assisted web interview (CAWI) method was employed to gather data. Information on gender, age, education, place of residence, income, and detailed perceptions of the impact of HTPs use and cigarette smoking on physical, mental, and social well-being was collected. A socioeconomic status score was derived based on education and income data. Multivariable multinomial regression analysis was used to assess the impact of socioeconomic status on perceptions of HTPs use and cigarette smoking in relation to physical, mental, and social well-being, controlling for age, place of residence, and perceived health status. The reference category was middle socioeconomic status and the middle category of perceived impact.

A total of 2,254 participants were included in the analysis. Socioeconomic status was not related with perceptions of the impact of HTPs use or cigarette smoking on physical well-being. Compared to those with middle socioeconomic status, individuals with low socioeconomic status were more likely to perceive a positive impact of HTPs use on mental well-being (OR = 1.71, 95% CI: 1.12–2.60). Women with low socioeconomic status showed a stronger perception of being unaffected by peer pressure, both against smoking cigarettes and using HTPs (OR = 1.69, 95% CI: 1.11–2.57; OR = 1.53, 95% CI: 1.10–2.12, respectively).

While socioeconomic status did not differentiate perceptions of the impact of HTPs use or smoking on physical health, more tailored public health strategies that consider socioeconomic factors may be needed when addressing mental health perceptions and the influence of peer pressure.