Introduction:
Heated tobacco products (HTPs) are promoted as less harmful than cigarettes and helpful for quitting cigarettes, which may erode public support for HTP control policies.

Objectives:
To investigate the association of positive perceptions of HTPs with support for HTP regulations.

Methods:
A landline survey using random-digit-dialing was conducted in Hong Kong (HK) in 2018. Among 5132 Chinese-speaking respondents aged 15+, perceived relative harm of HTPs (vs. cigarettes) was analyzed as “less/slightly less harmful” vs. “similarly/slightly more/more harmful” (“Don’t know” responses were excluded). Perceived HTPs as helpful for quitting cigarettes (yes/no) was recorded. Support (yes/no) for 5 individual policies and a total ban on HTPs was examined. Oversampling of current (N=1712) and ex-smokers (N=1707) were controlled by weighting according to the sex, age, and smoking status distribution of HK adults in 2018. Adjusted odds ratios (AORs) of supporting HTP regulations (individual policies, all 5 policies, at least 1 policy, total ban) in relation to positive perceptions of HTPs were calculated by multiple logistic regressions, adjusting for sex, age, educational attainment, monthly household income, having children, smoking status and ever HTP use.

Results:
Among 1368 respondents who were aware of HTPs, 32.3% perceived HTPs as less harmful and 21.1% perceived HTPs helpful for quitting cigarettes. Support for individual policies (ranged from 74.5% to 96.2%) was higher than that of a total ban (46.9%). Perceived HTPs as less harmful was associated with less support for “ban promotions and ads” (AOR 0.50, 95% CI 0.36-0.68), “ban use in smokefree areas” (0.53, 0.34-0.82), “ban sales to minors” (0.50, 0.25-0.98), all 5 policies (0.69, 0.53-0.92), at least 1 policy (0.11, 0.01-0.95) and “total ban” (0.57, 0.43-0.77). Similar negative associations were observed for perceived HTPs as helpful for quitting cigarettes.

Conclusion(s):
Positive perceptions of HTPs were associated with weaker support for HTP regulations in HK adults.

Funding:
Hong Kong Council on Smoking and Health