Use of IQOSTM (A Heated Tobacco Product) in Italy: Results from Two Cross-sectional Studies (Preprint)

Abstract

BACKGROUND Heated tobacco products (HTPs) such as IQOSTM are alternatives to cigarettes that heat rather than burn tobacco. Few data are available on the use of these products in Italy. OBJECTIVE To characterize how Italian adults use tobacco- and nicotine-containing products (TNPs), including smoke-free products such as IQOS, we surveyed Italian adults (users of legal age) about their current and past use of using smoke-free TNPs in from 2018 to 2020. METHODS We analyzed data from two consecutive cross-sectional surveys conducted in representative samples of the general adult population (6,095 subjects from 2018 to 2019 and 6,118 from 2019 to 2020) and IQOS users (1,371 subjects from 2018 to 2019 and 1,401 from 2019 to 2020) in Italy. We assessed the prevalence of current TNP use in the general population sample and the patterns of use in the IQOS users sample. RESULTS In the first cross-sectional study (2018-2019), cigarettes were the most used TNP (24.3%). Only small proportions used e-cigarettes or IQOS (1.4% and 0.7%, respectively). Nearly all current IQOS users were current adult cigarette smokers when they started using IQOS (98.0%). Some respondents used both IQOS and combustible TNPs (38.6%); however, most IQOS users (59.2%) exclusively used IQOS. Exclusive IQOS users reported improved respiratory symptoms (cough and phlegm) and exercise capacity compared to a year before they started using IQOS. Most current IQOS users also reported improved smell and taste, better smelling breath, and reduced teeth staining. Overall, these results were more pronounced among exclusive IQOS users. The results of the second cross-sectional study (2019-2020) were similar, except for a slight increase in IQOS use (1.1% vs. 0.7% from 2018 to 2019). CONCLUSIONS These studies show that most TNP users smoke cigarettes in Italy. The uptake of IQOS shows that it is a viable alternative to cigarettes; nearly all IQOS users switched from cigarettes to IQOS. Furthermore, most IQOS users exclusively use the product. Notably, respondents reported improved health, hygiene, and appearance after switching from cigarettes to IQOS.