Behavioral Intentions by Type of Tobacco Product Used in Response to a Flavor Regulation Policy

Background: This study aimed to examine future intentions regarding tobacco product use under a hypothetical flavor regulation among adult tobacco users in South Korea.Methods: An online survey was conducted among 3,400 adults aged 19-64 years throughout South Korea.Among flavored tobacco users (conventional cigarettes n=999; heated tobacco products n=766; e-cigarettes n=499), future use intentions under a hypothetical flavor restriction scenario were categorized as maintaining current use (e.g., through illicit sources), switching to non-flavored products within the same product category, switching to other flavored products, or quitting all tobacco products.Multinomial logistic regression analyses were performed, in which sociodemographic characteristics, multiple tobacco product use, and perceived harm of e-cigarettes were independent variables. Results:The flavored product use rate was high across all products (66.0%, 79.1%, and 72.5% for conventional cigarettes, heated tobacco products, and e-cigarettes, respectively).Under the flavor restriction scenario, the largest proportion of users indicated maintaining use by switching to non-flavored versions of their current products (approximately 35%-45%), followed by switching to other flavored tobacco products (29%-34%), whereas only 4.6%-8.0%indicated intentions to quit all tobacco products.Multiple tobacco product use was associated with a higher likelihood of switching to other flavored products, while the perceived harm of e-cigarettes was also associated with switching intentions.Conclusion: These findings suggest that effective policy should adopt a comprehensive flavor regulation covering all tobacco products, alongside targeted cessation support for multiple product users and clear risk communication regarding the harm caused by tobacco products.