Awareness, trial and use of heated tobacco products among adult cigarette smokers and e-cigarette users: findings from the 2018 ITC Four Country Smoking and Vaping Survey

Abstract

ObjectiveTo evaluate heated tobacco product (HTP) awareness, trial and current use among adult cigarette smokers and vaping product users in four countries with varying regulations governing HTP sales.DesignData came from Wave 2 of the ITC Four Country Smoking and Vaping Survey, collected from February to July 2018. Respondents were current and former smokers and/or users of vaping products (18 years or older) from Canada (CA; n=3778), England (EN; n=4848), the USA (US; n=2846) and Australia (AU; n=1515). At the time of the survey, only Canada and England permitted the sale of contemporary HTPs (eg, IQOS).ResultsOverall, 30.2% of respondents reported being aware of HTPs (CA=30.4%; EN=31.0%; US=30.2%; AU=27.4%; p=0.346), 2.4% had ever tried HTPs (CA=3.3%; EN=2.4%; US=2.0%; AU=0.9%; p=0.001) and 0.9% currently used HTPs at least monthly (CA=0.8%; EN=1.2%; US=0.7%; AU=0.2%; p<0.001). Trial and current use were higher among those who concurrently smoked and vaped (at least monthly) versus other nicotine use categories (trial: 10.9% v. 1.2%–2.0%, p<0.001; current use: 8.4% v. 0.1%–1.0%, p<0.001). In multivariable analyses, HTP awareness did not differ across countries, whereas odds of trial and current use were lower where HTPs were unavailable. Odds of HTP trial did not differ by regulatory environment when restricting analysis to HTP-aware concurrent smokers–vapers.ConclusionApproximately one third of respondents were aware of HTPs, even in the USA and Australia, where contemporary HTPs were not yet on the market. Trial and use were uncommon, except among concurrent smokers–vapers. Restrictions on availability may have limited HTP use generally, but less so for concurrent smokers–vapers.

Heated Tobacco Products and Nicotine Pouches: A Survey of People with Experience of Smoking and/or Vaping in the UK

“…Overall, current use appears not to have increased (for example 2.0% among current smokers in 2017 compared with 1.7% among exclusive smokers in this survey). Prevalence among smokers, recent ex-smokers and vapers in the present survey was consistent with previous surveys [29].…”

“…If these products help smokers to stop and/or are significantly less harmful, then more needs to be done to increase their use among exclusive smokers. Regulatory restrictions may then need to be reconsidered, although a crosscountry study only found small differences between countries varying even on legal availability [29].…”

“…Use was very rare [24,27] or non-existent [28] among those who had not smoked, higher among those with higher education or income [24,26,28] and higher among younger age groups [24,26,28], although this was not the case in Japan [27]. A survey in Australia, Canada, England and the US in 2018 among current and former smokers and/or vapers found overall just under one-third were aware of HTPs, 2.4% had ever tried and 0.9% were current at least monthly users, with trial and current use higher among those who also smoked and vaped (8.4%) [29].…”

Evolution of tobacco products: recent history and future directions

“…Current HTP use rose in Japan from 0.2% in 2015 to 10%-15% in 2019, [30][31][32] and 4.4% of adults in Korea currently use an HTP. 33 Prevalence has been lower across European countries (eg, 0.1% current users in 2016-2018), 34 but seems to be increasing in select markets (eg, 1.1%-Italy 2019 35 ; 1.2%-England 36 ).…”

Cooling off the heated controversy of a safer cigarette: heat-not-burn no better than traditional combustion cigarettes

“…This assertion requires further elucidation, due to a paucity of studies on long-term health effects of HNBC and the increasing use of HNBC, especially among current TCC smokers. 1 Therefore, the two reports in this issue of Thorax, by Loffredo et al and Kanai et al, 2 3 two research groups unaffiliated with tobacco industry, are timely, providing new insights into the harmful impact of chronic HNBC use on endothelial function and questioning its usefulness for tobacco cessation, respectively.…”