Survey on the awareness, use of and attitude of trying heated tobacco products in middle school and college students in Guangzhou city: a cross-sectional survey

ObjectiveTo investigate the awareness, use, and attitudes toward heated tobacco products (HTPs) among middle and college students in Guangzhou city, Guangdong province. MethodsFrom January to March 2024, a stratified cluster random sampling method was used to conduct a self-administered questionnaire survey among 10 069 middle and college students in Guangzhou city. The survey collected information on demographics, smoking status, smoking severity index, HTP awareness, ever-use, current use, attitudes toward trying HTPs, and reasons for trying HTPs. Data were analyzed using descriptive statistics, comparative analysis, and association rule mining. ResultsA total of 8 377 valid questionnaires were collected. The current smoking rate among the surveyed students was 4.64%. Regarding HTP awareness, 27.40% had "heard of" HTPs and 21.11% had "seen" them. Current smokers (38.30% "heard of", 37.53% "seen") and college students (32.26% "heard of", 24.14% "seen") had higher HTP awareness (P <0.05). The ever-use rate of HTPs was 0.13%, and the current use rate was 0.08%. Among current smokers, males with severe tobacco dependence and smoking family members or friends (5.77%) and college students with below-average economic status (8.57%) had a higher probability of current HTP use than the overall rate (1.80%). Regarding attitudes toward trying HTPs, 3.41% were "very interested" and 4.72% were "somewhat interested." The most common reasons for trying HTPs were "less harmful to health" (24.67%), "simply like it, no particular reason" (24.23%), "curiosity" (13.36%), and "can reduce smoking" (10.28%). College students (4.72% "very interested", 8.32% "somewhat interested") and current smokers (11.57% "very interested", 18.51% "somewhat interested") showed greater interest in trying HTPs (all P <0.05). Never-smokers with above-average economic status and smoking family members or friends (21.37%) and current smokers with severe tobacco dependence (25.86%) had a higher probability of being interested in trying HTPs than the overall population.ConclusionsThe extremely low HTP use rate among middle and college students in Guangzhou city reflects the effectiveness of tobacco control efforts in China, but challenges remain. Continued efforts are needed to prohibit the sale and promotion of HTPs and to further strengthen tobacco control efforts for students, especially specific subgroups, through school policies, teacher and school doctor training, and student-targeted interventions.