# Dual use of novel tobacco products and socioeconomic paradox in smoking cessation: An age-period-cohort analysis of KNHANES data 2007–2022

## TL;DR

This study explores how socioeconomic factors and new tobacco product use affect smoking cessation intentions in South Korea from 2007 to 2022.

## Contribution

The study introduces an age-period-cohort analysis of dual tobacco product use and its impact on smoking cessation intentions in South Korea.

## Key findings

- Dual users of conventional cigarettes and new tobacco products were less likely to intend to quit smoking.
- Smoking cessation intentions peaked at age 35 and declined with age.
- Policy changes after 2016 reduced overall quit intentions but increased them among dual users.

## Abstract

Despite significant declines in smoking prevalence, South Korea faces stagnation linked to new tobacco product (NTP) adoption. This study examines sociodemographic and temporal drivers of smoking cessation intentions, with an emphasis on dual use of conventional cigarettes and NTPs.

We analyzed pooled secondary and nationally representative data from the Korea National Health and Nutrition Examination Survey 2007–2022 (n=37142) using an age period-cohort model via the Intrinsic Estimator. The analytic sample included adults aged ≥20 years who reported current smoking of conventional cigarettes or dual use with NTPs. Outcomes were intentions to quit within 1 and 6 months, adjusting for dual use status, sociodemographics, household factors, and applying survey weights.

Dual users accounted for 6.4% of smokers, were more often college graduates (51.5% vs 37.0%, p<0.001) yet less likely to plan quitting. After adjusting for other covariates, cessation intentions peaked at the age of 35 years (adjusted prevalence odds ratio POR=1.111; 95% CI: 1.105–1.116) then declined by 23.1% by the age of 70 years. Following 2016 policy changes, intentions decreased overall (POR decreased from 1.012 to 0.994), while dual users showed an opposite period trend (POR increased from 0.966 to 1.022). Birth cohorts from 1947–1950 had higher intentions (POR=1.058; 95% CI: 1.051–1.064), contrasting with decreases in post-1955 cohorts (POR=0.969; 95% CI: 0.943–0.994).

These findings demonstrate that socioeconomic and temporal factors are associated with quit intentions among Korean smokers. Future longitudinal and cross-country studies are needed to confirm these associations and to examine product-specific patterns and contextual influences, providing a broader understanding of how cessation intentions evolve in changing tobacco markets.