Use Of Heated Tobacco Products Research Articles

Patterns of Emerging Tobacco Product Use Among U.S. Adults, 2019-2022.

Quantifying the use of emerging tobacco products such as nicotine pouches (NPs) and heated tobacco products (HTPs) is crucial for informing public health interventions and measuring their potential effects on tobacco use morbidity, mortality and benefits from complete tobacco cessation. Using data from the May 2019 and September 2022 cycles of the Tobacco Use Supplement to the Current Population Survey (TUS-CPS), we calculated U.S. population-wide estimates of ever and/or current use of NPs and HTPs by key socio-demographic characteristics, cigarette smoking status and preference of characterizing flavors in NPs. We present weighted frequencies, proportions and associated 95% confidence intervals. Analyses were conducted in 2024. In both survey cycles, a substantial fraction of adults who ever used HTPs had never smoked cigarettes (52.0% in 2019; 27.4% in 2022). Among those who currently used HTPs or NPs (2022 only), many reported having never smoked cigarettes (42.5% and 41.4%, respectively), while many also reported currently smoking (32.2% and 24.8%, respectively). We observed similar sociodemographic characteristics across use of both HTPs and NPs. Mint was the most common flavor choice among adults who currently used NPs (52.8%). Continued surveillance of emerging tobacco products such as HTPs and NPs can inform public health approaches and support future research to better quantify the health consequences from these products.

Level of tobacco dependence and beliefs towards heated tobacco products

Abstract Nicotine dependence affects not only behaviors related directly to smoking, quit attempts or looking for alternative products but also beliefs about smoking. We sought to assess whether the level of tobacco dependence is associated with beliefs and feelings towards heated tobacco products (HTP) and to assess the relationship between tobacco dependence and the motivators to quit HTP use. Random population sample of Polish citizens aged 18+ years, former smokers, current HTP users was recruited. Tobacco dependence was assessed using 5 question; participants were classified into two groups of tobacco dependence (low or high) using a two-stage cluster analysis. An extensive questionnaire on beliefs on HTP use was administered. The χ2 test and logistic regression were used. There were 2,500 participants (62.6% women) of median age=36 years (Q1=29, Q3=45). The median number of years of smoking was 10 (Q1=5, Q3=15) and median number of years of HTP use was 2 (Q1=1, Q3=3). High tobacco dependence was found in 958 (38,3%) participants. Compared to low dependence, high tobacco dependence was related with feeling of strong need for HTP use (69.7% vs. 47.6%, p < 0,001). High level of tobacco dependence was positively related to perceived social pressure against smoking (72.9% vs. 44.9%, p < 0,001), but it did not differentiate perceived social pressure against HTP use. Compared to low tobacco dependence, participants with high tobacco dependence more often indicated fear of illness OR = 1,73 95%CI=1,46-2,07, own resolution OR = 1,32 95%CI =1,12-1,55 and price OR = 1,34 95%CI=1,13-1,59 as possible motivators to quit HTP use. Level of tobacco dependence in former smokers shaped beliefs and feelings towards HTP use. High tobacco dependence contributed to strong need to use HTP and also increased perception of social pressure against smoking, but not against using HTP. It also increased the importance of fear of illness, price and one’s own resolution as motivators to quit HTP use. Key messages • High level of tobacco dependence in former smokers results in stronger perceived social pressure against smoking but not against HTP use. • High tobacco dependence in former smokers is related with stronger need to use HTP.

Exposure to e-cigarette and heated tobacco product advertisements via digital, traditional media, and points-of-sale: An examination of associations with use intentions and perceived risk among adults in Armenia and Georgia.

E-cigarette and heated tobacco product (HTP) marketing often leverages digital media and points-of-sale (POS) and advertises risk reduction, including in Armenia and Georgia where male cigarette use rates are high. Using 2022 survey data from Armenian and Georgian adults (n=1468, mean age=42.92 years, 51.4% female; and past-month use of e-cigarettes 3.2%, HTPs 2.7%, and cigarettes 31.6%), multivariable linear regression examined 4 outcomes - e-cigarette and HTP use intentions and perceived risk (1=not at all, to 7=extremely) - in relation to past-month e-cigarette or HTP advertisement exposure via digital media, traditional media, and POS, controlling for covariates (country, age, gender, education level, relationship status, children, past-month cigarette and e-cigarette/HTP use). E-cigarette and HTP use intentions were low (mean score=1.47, SD=1.39 each), while perceived risk was high (mean score=5.83, SD=1.6, and mean score=5.87, SD=1.56, respectively). Past-month exposure to e-cigarette and HTP advertisements, respectively, were 12.9% and 11.2% via digital media, 6.1% and 4.8% traditional media, and 22.5% and 21.1% POS. For e-cigarettes, ad exposure via digital media was associated with greater use intentions (β=0.24; 95% CI: 0.03-0.44), ad exposure via traditional media (β= -0.32; 95% CI: -0.55 - -0.09) and POS (β= -0.30; 95% CI: -0.60 - -0.004) was associated with lower risk perceptions. For HTPs, ad exposure via digital media (β=0.35; 95% CI: 0.14-0.56) and POS (β=0.21; 95% CI: 0.04-3.63) was associated with greater use intentions, and ad exposure at POS was associated with lower risk perceptions (β= -0.23; 95% CI: -0.42 - -0.03). Tobacco control efforts should monitor and regulate e-cigarette and HTP marketing, particularly via digital media which may effectively promote use, and via POS which may target and influence risk perceptions.

Impacts of revised smoke-free regulations under the 2020 Japan Health Promotion Act on cigarette smoking and heated tobacco product use in indoor public places and homes: findings from 2018 to 2021 International Tobacco Control (ITC) Japan Surveys

BackgroundIn April 2020, Japan’s revised Health Promotion Act (HPA) banned cigarette smoking and heated tobacco products (HTP) use in indoor public places but exempted small establishments and permitted smoking-designated/HTP-designated rooms....

Association between use of heated tobacco products and long-term respiratory effects considering smoking history: internet-based cross-sectional study in Japan

BackgroundWith the use of heated tobacco products (HTPs) becoming more widespread in Japan, interest in the health effects of HTP has grown. Since the majority of HTP users are former smokers, information about the user’s smoking history and health status before HTP use is needed when assessing the health effects of HTP use. The limited epidemiological studies available did not consistently consider this information adequately, therefore we conducted a cross-sectional study investigating the association between HTP use and respiratory chronic diseases and symptoms.MethodsThe questionnaires were sent to a research panel members in Japan via the Internet, and individuals who met the study criteria and were either current exclusive HTP users, current exclusive cigarette users or those had never used tobacco products were selected. Information about the participants’ smoking history and health status before they used HTPs was obtained. The effects of participant smoking history before HTP use and the impacts on outcomes upon switching to HTP were assessed using a logistic regression model. The odds ratio (OR) for current exclusive HTP users relative to never tobacco users was calculated. The OR was calculated under two scenarios, one in which the smoking history was ignored or one in which the smoking history was considered.ResultsOf the participants from whom responses to the questionnaires were obtained, 17,406 participants were included in the analysis. Almost all participating current exclusive HTP users had a history of long-term smoking (mean: 30.8 years), and the occurrence of outcomes both before and after the start using HTP was reported. The ORs, without adjustment and with adjustment for smoking history before HTP use were, 3.23 (95% CI: 1.37–7.61) and 1.85 (95% CI: 0.70–4.89) respectively in COPD, same as other outcomes.ConclusionsThese results suggest that smoking history before HTP using affects the occurrence of outcomes, and underscore the importance of considering smoking history when assessing the health effect of HTP use. Since the duration of HTP use is considerably shorter than that of cigarette use at present, further research, such as follow-up surveys assessing the long-term respiratory effects of HTP use, will be necessary.

Shifts in motivation to quit cigarette smoking associated with IQOS use

IntroductionIQOS, a heated tobacco product (HTP), is among a growing number of noncombustible nicotine delivery alternatives marketed to people who smoke combustible cigarettes and are interested in less harmful alternatives. Little is known regarding whether IQOS use and IQOS-associated effects impact motivation to quit cigarette smoking. MethodsNon-treatment-seeking adult daily smokers (n = 87) completed a within-subjects study consisting of a baseline ad-lib smoking period (days 1–5), two laboratory visits (days 6–7) involving IQOS exposure, and a two-week period where participants were instructed to switch from smoking cigarettes to using IQOS (days 8–21). Motivation to quit smoking was measured on days 1 and 22. ResultsA generalized linear model revealed a significant increase in motivation to quit smoking across the 14-day switch phase with an increase of 1.47 ladder steps (Δ=1.47, sd = 1.98, t(86) = 6.92, p < 0.0001), increasing from 5.30 to 6.80. Candidate predictors were identified through a stepwise selection procedure, which resulted in a final model with two predictors, the standardized HeatStick substitution rate (b = 0.54, (CI95% 0.13–0.95), p = 0.01) and standardized relative risk perception score (b = 0.45, (CI95% 0.04–0.85) p = 0.03), ConclusionsAmong those uninterested in quitting cigarette smoking within the next month, IQOS use was associated with increased motivation to quit. Motivation to quit smoking may not be a necessary prerequisite for promoting smoking behavior change but rather bolstered by smoking behavior change in the context of HTP use. Greater perceptions of risk reduction may ultimately aid the transition from combustible to noncombustible tobacco products.

Evaluation of environmental emissions from glo heated tobacco products and combustible Cigarettes

Compared to cigarette smoke, heated tobacco product (HTP) aerosol contains significantly fewer and lower levels of harmful and potentially harmful constituents (HPHCs). However, the impact on environmental air is relatively unexplored. Therefore, this study compared levels of secondhand aerosol (SHA) constituents in air following glo HTP use with secondhand smoke (SHS) constituents following cigarette smoking in an environmental test chamber (ETC). Extracted ETC air samples following product use sessions were analyzed for 27 SHS/SHA constituents, including HPHCs. The use of glo HTPs resulted in significantly lower SHA HPHC levels in the ETC air relative to SHS HPHC levels from cigarette smoking. Some aerosol constituents (benzene, CO, formaldehyde, nicotine, respirable suspended particles, toluene, ethylbenzene, fine particulate matter, m- and p-cresol, o-cresol, pyridine, styrene, and ultraviolet particulate matter) were either below the limit of detection in ETC air or at significantly low levels following glo HTP use relative to cigarette smoking. Mean concentrations of the assessed constituents were at least 90 % lower following use of glo HTPs compared to smoking combustible cigarettes. These results suggest that glo HTP use would not contribute significantly to indoor air contamination and would reduce non-user exposure to HPHCs and other harmful constituents relative to combustible cigarettes. Such reductions in non-user exposure should be considered when assessing the tobacco harm reduction potential of glo HTPs.

Association of conventional cigarette smoking, heated tobacco product use and dual use with hypertension.

Heated tobacco products (HTPs) have emerged as alternatives to conventional cigarettes. However, their health effects remain largely unknown. This study aimed to prospectively explore the association between the use of cigarettes and HTPs and the risk of hypertension. This cohort study analysed data from 30152 workers (82.0% men, mean age 42.9 ± 11.0 years) who were initially free of hypertension, participating in the Japan Epidemiology Collaboration on Occupational Health Study. Participants were categorized into five groups based on their self-reported tobacco product use: never smokers, past smokers, exclusive cigarette smokers, exclusive HTP users and dual users of cigarettes and HTPs. Hypertension cases were identified using three data points from annual health checkup data collected between 2019 and 2021. Cox proportional hazards regression models were used to investigate the association between tobacco product use and hypertension. During a mean follow-up of 2.6 years (range: 0.1-4.0 years), 3656 new cases of hypertension were identified. Compared with never smokers, the risk of hypertension was higher among exclusive cigarette smokers [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.13-1.41] and exclusive HTP users (HR 1.19, 95% CI 1.06-1.34). There was also a suggestion of increased risk of hypertension among dual users (HR 1.16, 95% CI 0.98-1.38). Furthermore, the risk of hypertension increased with the intensity of cigarette/HTP use in all tobacco product users. Similarly, both cigarette smoking and HTP use elevate the risk of hypertension. HTPs should not be regarded as less harmful alternatives to traditional cigarettes for preventing hypertension.

Electronic Cigarette and Heated Tobacco Product Use and Their Association With Tobacco Control Factors Among Adults in Indonesia, Kazakhstan, and the Philippines.

Data on e-cigarette (EC) and heated tobacco product (HTP) use and the reasons for their use are useful for policy making. We report comparable nationally representative estimates of EC and HTP use and their associated factors. Global Adult Tobacco Survey data from Indonesia (2021), Kazakhstan (2019), and the Philippines (2021) were analyzed. The weighted prevalence rates and 95% CI of EC and HTP awareness, current use, and ever use, and their distribution by cigarette smoking status were calculated. Binary logistic regression analyses assessed socioeconomic, and tobacco control factors associated with EC and HTP use. The prevalence (%) of EC awareness, ever use and current use were 48.7-69.4, 3.6-8.8, and 1.9-3.0, respectively. The prevalence(%) of HTP awareness, ever use and current use were 2.7-21.7, 0.2-2.1, and 0.1-1.2, respectively. The main reasons for EC and HTP use were attractive flavors(45.8%-73.9%), less harmful than smoking(23.0%-70.1%), and enjoyment(40.8%-76.7%). Avoiding going back to smoking(0.9%-54.4%) and quitting smoking(19.4%-49.8%) were less frequently cited reasons (except in the Philippines). EC/HTP use was associated with younger age, higher education and wealth, current/past smoking, exposure to information about the dangers of tobacco use, and advertisements about tobacco products and smoke-free rules at home. The prevalence of EC and HTP use was higher among younger men with higher education and wealth, and current/past smoking. EC and HTP use should be closely monitored. Regulations to restrict the widespread marketing and sales of EC and HTP are needed to prevent the escalation of their use. The population-level data provide the benchmark for future monitoring use of e-cigarettes and HTPs and identify population subgroups for future surveillance in low- and middle-income countries. The association of EC/HTP use with tobacco control-related factors provides leads for policies that should be formulated and implemented to regulate the product contents, marketing, and sales of EC and HTP.

Attitudes toward smoking cessation according to smoking status among dentists in the Aichi Dental Association in Japan.

The prevalence of smoking, including heated tobacco products (HTPs), among Japanese dentists was reported to be 16.5%, significantly higher than that among Japanese physicians and United States dentists. However, large-scale studies on smoking cessation implementation based on dentists' smoking status and perceptions since the introduction of HTPs are lacking. Therefore, we aimed to investigate and assess dentists' attitudes toward smoking, including HTP use and smoking cessation, according to smoking status. A self-administered questionnaire comprising six major items was mailed to 3883 dentists who were members of the Aichi Dental Association in August 2019. The primary outcome was smoking cessation status. The secondary outcome was the impact of smoking on intervention for smoking cessation. This study was reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Among the 1317 (42%) dentists analyzed, men were more positive toward smoking than women. Current and former smokers were more positive about smoking than never smokers/users, regardless of the tobacco product type. Additionally, the current smoker group using conventional cigarettes was less likely to ask for their patients' smoking status than the never smoker group. Furthermore, the current smoker (OR=2.0; 95% CI: 1.3-3.1 vs never smoker) and HTP user (OR=1.9; 95% CI: 1.2-3.1 vs never user) groups were less likely to engage in smoking cessation than the never smoker/user groups, regardless of the tobacco product type. Since the smoking status of dentists affects the implementation of smoking cessation interventions, it is crucial to encourage them to quit using all tobacco products to promote smoking cessation interventions in dental practice. Additionally, providing proper smoking prevention education to dentists is an important task.

A Scoping Review of Behavioural Studies on Heated Tobacco Products.

Heated tobacco products (HTPs) are electronic devices that heat tobacco sticks to temperatures much lower than those which cause pyrolysis and combustion in cigarettes. While this electrical heating causes the formation of an inhalable aerosol which contains nicotine, the aerosol from HTPs contains significantly fewer and lower levels of the harmful and potentially harmful chemicals found in cigarette smoke. As a result, HTP use potentially conveys reduced risks to health compared to cigarette smoking. While this relative reduction in individual health risk is becoming clearer, what is less certain is the impact of HTPs on overall population‑level health, taking into account both the potential positive impact on adult smokers who completely switch to using HTPs and any unintended impacts such as use by tobacco non‑users and particularly by youth.The aim of this scoping review was to collate and evaluate the published scientific evidence to date, with acut‑off of 1 January 2024, investigating the impact of HTPs on population‑level health.This evaluation suggests that HTP use is almost exclusively observed among those with a history of cigarette smoking, and there is a growing body of evidence for the ability of HTPs to provide support for adult smokers to transition away from cigarette smoking, in the absence of any significant "gateway" into tobacco use initiation. Many studies have reported a significant degree of dual use of cigarettes and HTPs, and efforts to assess the reasons for such patterns of use, whether these provide overall exposure reductions, and whether dual use acts as a bridge towards a complete transition away from cigarette smoking, requires further investigation. In addition, correction of the widespread and increasing misperceptions of HTPs among adult smokers is recommended to promote HTP uptake as a potentially less harmful alternative to smoking in this population.

Effects of Combustible Cigarettes and Heated Tobacco Products on Systemic Inflammatory Response in Patients with Chronic Inflammatory Diseases.

Smoke derived from combustible cigarettes (CCs) contains numerous harmful chemicals that can impair the viability, proliferation, and activation of immune cells, affecting the progression of chronic inflammatory diseases. In order to avoid the detrimental effects of cigarette smoking, many CC users have replaced CCs with heated tobacco products (HTPs). Due to different methods of tobacco processing, CC-sourced smoke and HTP-derived aerosols contain different chemical constituents. With the exception of nicotine, HTP-sourced aerosols contain significantly lower amounts of harmful constituents than CC-derived smoke. Since HTP-dependent effects on immune-cell-driven inflammation are still unknown, herein we used flow cytometry analysis, intracellular staining, and an enzyme-linked immunosorbent assay to determine the impact of CCs and HTPs on systemic inflammatory response in patients suffering from ulcerative colitis (UC), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD). Both CCs and HTPs significantly modulated cytokine production in circulating immune cells, affecting the systemic inflammatory response in COPD, DM, and UC patients. Compared to CCs, HTPs had weaker capacity to induce the synthesis of inflammatory cytokines (IFN-γ, IL-1β, IL-5, IL-6, IL-12, IL-23, IL-17, TNF-α), but more efficiently induced the production of immunosuppressive IL-10 and IL-35. Additionally, HTPs significantly enhanced the synthesis of pro-fibrotic TGF-β. The continuous use of CCs and HTPs aggravated immune-cell-driven systemic inflammation in COPD and DM patients, but not in UC patients, suggesting that the immunomodulatory effects of CC-derived smoke and HTP-sourced aerosols are disease-specific, and need to be determined for specific immune-cell-driven inflammatory diseases.

Exposure to serum from exclusive heated tobacco product smokers induces mTOR activation and fibrotic features in human cardiac stromal cells

Chronic smokers have increased risk of fibrosis-related atrial fibrillation. The use of heated-tobacco products (HTPs) is increasing exponentially, and their health impact is still uncertain. We aim to investigate the effects of circulating molecules in exclusive HTP chronic smokers on the fibrotic behavior of human atrial cardiac stromal cells (CSCs). CSCs were isolated from atrial tissue of elective cardiac surgery patients, and exposed to serum lots from young healthy subjects, stratified in exclusive HTP smokers, tobacco combustion cigarette (TCC) smokers, or nonsmokers (NS). CSCs treated with TCC serum displayed impaired migration and increased expression of pro-inflammatory cytokines. Cells cultured with HTP serum showed increased levels of pro-fibrotic markers, and reduced expression of connexin-43. Both TCC and HTP sera increased collagen release and reduced secretion of angiogenic protective factors from CSCs, compared to NS serum. Paracrine support to tube-formation by endothelial cells and to viability of cardiomyocytes was significantly impaired. Treatment with sera of both smokers groups impaired H2O2/NO release balance by CSCs and reduced early phosphorylation of several pathways compared to NS serum, leading to mTOR activation. Cotreatment with rapamycin was able to reduce mTOR phosphorylation and differentiation into aSMA-positive myofibroblasts in CSCs exposed to TCC and HTP sera. In conclusion, the circulating molecules in the serum of chronic exclusive HTP smokers induce fibrotic behavior in CSCs through activation of the mTOR pathway, and reduce their beneficial paracrine effects on endothelial cells and cardiomyocytes. These results point to a potential risk for cardiac fibrosis in chronic HTP users.

"Keep it a secret": leaked documents suggest Philip Morris International, and its Japanese affiliate, continue to exploit science for profit.

The tobacco industry has a long history of manipulating science to conceal the harms of its products. As part of its proclaimed transformation, the world's largest tobacco company, Philip Morris International (PMI), states it conducts "transparent science". This paper uses recently leaked documents from PMI and its Japanese affiliate, Philip Morris Japan (PMJ), to examine its contemporary scientific practices. 23 documents dating 2012 through 2020 available from Truth Tobacco Industry Documents Library were examined using Forster's hermeneutic approach to analysing corporate documentation. Thematic analysis using the Science for Profit Model was conducted to assess whether PMI/PMJ employed known corporate strategies to influence science in their interests. PMJ contracted a third-party external research organisation, CMIC, to covertly fund a study on smoking cessation conducted by Kyoto University academics. No public record of PMJ's funding or involvement in this study was found. PMJ paid life sciences consultancy, FTI-Innovations, ¥3,000,000 (approx. £20,000) a month between 2014 and 2019 to undertake extensive science-adjacent work, including building relationships with key scientific opinion leaders and using academic events to promote PMI's science, products and messaging. FTI-Innovation's work was hidden internally and externally. These activities resemble known strategies to influence the conduct, publication and reach of science, and conceal scientific activities. The documents reveal PMI/PMJ's recent activities mirror past practices to manipulate science, undermining PMI's proclaimed transformation. Tobacco industry scientific practices remain a threat to public health, highlighting the urgent need for reform to protect science from the tobacco industry's vested interests.Implications: Japan is a key market for PMI, being a launch market for IQOS and having the highest heated tobacco product use globally. Our findings, in conjunction with other recent evidence, challenge PMI's assertion that it is a source of credible science and cast doubt on the quality and ethical defensibility of its research, especially its studies conducted in Japan. This, in turn, brings into question the true public health impacts of its products. There is urgent need to reform the way tobacco-related science is funded and conducted. Implementation of models through which research can be funded using the industry's profits while minimising its influence should be explored.

Evaluating trends in cigarette and HTP use in Japan and measurement issues in the National Health and Nutrition Survey

IntrodutionStudies have reported that the rapid rise in heated tobacco product (HTP) sales in Japan accompanied an accelerated decline in cigarette sales. However, these studies do not distinguish whether those...

Heated tobacco product use frequency, smoking quit attempts, and smoking reduction among Mexican adult smokers.

Heated tobacco products (HTPs) are promoted as less harmful than cigarettes; nonetheless, whether HTPs help smokers quit is uncertain. Data from 4067 Mexican adult smokers surveyed longitudinally every four months (November 2019-March 2021) were analyzed. Mixed-effects multinomial models regressed HTP use frequency (no use=reference; monthly; weekly; and daily use) on sociodemographics and tobacco/nicotine-related variables. Among participants who completed at least two surveys (n=2900) over four months, the duration of their longest smoking quit attempt (SQA) between surveys (SQAs: <30 days; ≥30 days; no SQA=reference) was regressed on HTP use frequency, and changes in the number of cigarettes smoked per day were regressed on HTP initiation between surveys, adjusting for covariates. Consistent predictors of all HTP use frequencies (monthly, weekly, or daily vs no use) were daily smoking >5 cigarettes (ARRR=1.69 [95% CI: 1.12-2.55], 1.88 [95% CI: 1.26-2.81] and 6.46 [95% CI: 3.33-12.52], respectively); e-cigarette use (ARRR =5.68 [95% CI: 3.38-9.53], 6.54 [95% CI: 4.06-10.55] and 2.59 [95% CI: 1.26-5.30]); lower HTP risk perceptions (ARRR=2.12 [95% CI: 1.50-30.00], 2.25 [95% CI: 1.63-3.10] and 2.00 [95% CI: 1.25-3.22]); exposure to HTP information inside (ARRR=2.13 [95% CI: 1.44-3.15], 2.13 [95% CI: 1.49-3.05] and 3.72 [95% CI: 2.28-6.09]) and outside stores (ARRR=2.36 [95% CI: 1.56-3.57], 2.32 [95% CI: 1.65-3.25] and 2.44 [95% CI: 1.41-4.24]) where tobacco is sold; having family (ARRR=2.46 [95% CI: 1.54-3.91], 2.90 [95% CI: 1.93-4.37] and 2.96 [95% CI: 1.52-5.77]) and friends (ARRR=5.78 [95% CI: 3.60-9.30], 4.98 [95% CI: 3.22-7.72] and 6.61 [95% CI: 2.91-15.01]) who use HTPs. HTP use frequency was not associated with quit attempts, except for monthly HTP use predicting SQAs lasting ≥30 days (ARRR=2.12 [95% CI: 1.17-3.85]). Initiation of HTP use was not associated with changes in smoking frequency. Limiting analysis to those who intend to quit smoking also yielded null results. Among Mexican adult smokers, frequency of HTP use was mostly not associated with either cessation behaviors or changes in cigarette consumption, suggesting that HTPs have limited to no effectiveness for smoking cessation.

Association of conventional cigarette smoking, heated tobacco product use, and dual use with hearing loss: A working population-based study.

Although conventional cigarette smoking has been linked to an increased risk of hearing loss, the association between heated tobacco products (HTPs) and hearing loss is unknown. The objective of this study was to investigate the association between cigarette and HTP use and hearing loss. This cross-sectional study examined the data of 7769 employees from five companies (Study I) and 34404 employees from a large company (Study II), all participants in the Japan Epidemiology Collaboration on Occupational Health Study. The participants were categorized into five groups based on their self-reported tobacco use: never smokers, former smokers, exclusive cigarette smokers, exclusive users of HTPs, and those who used both cigarettes and HTPs. Hearing levels were measured using pure-tone audiometry at 1 and 4 kHz frequencies. Separate analyses were carried out for each study, and the results were then combined using fixed-effect models to pool the estimates. The analysis included 42173 participants, with a prevalence of 12.9% for exclusive cigarette smoking, 9.8% for exclusive HTP use, and 5.5% for dual use. The pooled adjusted odds ratios with 95% confidence intervals for unilateral hearing loss at 4 kHz were 1.21 (95% CI: 1.10-1.33) for former smokers, 1.83 (95% CI: 1.64-2.05) for exclusive cigarette smokers,1.46 (95% CI: 1.28-1.67) for exclusive HTP users, and 1.66 (95% CI: 1.41-1.96) for dual users, compared to never smokers. Additionally, the adjusted odds ratios for hearing loss at 4 kHz among exclusive cigarette smokers, exclusive HTP users, and dual users increased with the intensity of cigarette/HTP consumption (all p for trend <0.001). No significant associations were found between exclusive HTP use, dual use, and hearing loss at 1 kHz, apart from exclusive cigarette smoking. In this cross-sectional study, associations were found between exclusive cigarette smoking, exclusive HTP use, dual use, and hearing loss, particularly at 4 kHz. Further research is needed to confirm these findings.

Heated tobacco product marketing: a mixed-methods study examining exposure and perceptions among US and Israeli adults.

The marketing of heated tobacco products (HTPs), like IQOS, influences consumers' perceptions. This mixed-methods study analyzed (i) survey data (2021) of 2222 US and Israeli adults comparing perceptions of 7 IQOS attributes (design, technology, colors, customization, flavors, cost and maintenance) and 10 marketing messages (e.g. 'Go smoke-free…') across tobacco use subgroups and (ii) qualitative interviews (n = 84) regarding IQOS perceptions. In initial bivariate analyses, those never using HTPs (86.2%) reported the least overall appeal; those currently using HTPs (7.7%) reported the greatest appeal. Notably, almost all (94.8%) currently using HTPs also currently used cigarettes (82.0%) and/or e-cigarettes (64.0%). Thus, multivariable linear regression accounted for current cigarette/e-cigarette use subgroup and HTP use separately; compared to neither cigarette/e-cigarette use (62.8%), cigarette/no e-cigarette use (17.1%) and e-cigarette/no cigarette use (6.5%), those with dual use (13.5%) indicated greater overall IQOS appeal (per composite index score); current HTP use was not associated. Qualitative data indicated varied perceptions regarding advantages (e.g. harm, addiction and complexity) of IQOS versus cigarettes and e-cigarettes, and perceived target markets included young people, those looking for cigarette alternatives and females. Given the perceived target markets and particular appeal to dual cigarette/e-cigarette use groups, IQOS marketing and population impact warrant ongoing monitoring to inform regulation.

Impact of exposures to Heated Tobacco Products in the media and through social connections on product perceptions and use.

Little is known about media exposures to heated tobacco products (HTPs). In this study, we examined sources of HTP exposure, including from paid and unpaid media and social connections, in relation to HTP use and use intentions. In the fall of 2021, we conducted a cross-sectional survey among adult online panelists (aged 18-45 years) in the US and Israel, oversampling tobacco users. The current study analyzed data from participants who responded to the question about HTP awareness or use (n=2061). Multivariable linear and logistic regression analyses examined the relationship between sources of HTP exposure, HTP use, and use intentions. Among those aware of HTPs, both Israelis and Americans reported past-month HTP media exposure via advertisements (58.2% vs 48.0%), non-advertisement sources (49.7% vs 30.7%), and social connections (51.5% vs 33.6%), respectively. Factors associated with HTP awareness (n=677/2061; 32.9%) included media use frequency (AOR=1.13; 95% CI: 1.01-1.28) and social connections using HTPs (AOR=2.45; 95% CI: 1.92-3.15). Among those aware of HTPs, past-month HTP exposure via digital media advertisements (AOR=2.06; 95% CI: 1.09-3.91) and non-advertising promotion via radio, podcast, movie, television or theatre (AOR=2.30; 95% CI: 1.19-4.44) and websites (AOR=2.36; 95% CI: 1.32-4.21) were associated with current HTP use. Exposure to digital media advertisements (β=0.35; 95% CI: 0.07-0.62) and non-advertising promotion via social media (β=0.62; 95% CI: 0.34-0.91) were correlated with higher use intentions. Having social connections using HTPs was correlated with higher use (AOR=2.21; 95% CI: 1.19-4.11) and intentions (β=0.66; 95% CI: 0.42-0.91). No significant differences were found across countries. Digital media (e.g. online, social media) were particularly salient correlates of HTP intentions and use. Future studies are needed that further examine media exposures to these products, as well as that examine possible regulations to limit HTP promotion via these channels.

Perceptions of Heated Tobacco Products (HTPs) Versus Cigarettes and e-Cigarettes in Relation to Likelihood of Trying HTPs or Suggesting HTPs to Those who Smoke Cigarettes.

Heated tobacco products (HTPs), like IQOS, are marketed as innovative, stylish, harm-reduction products distinct from cigarettes and e-cigarettes. Research is needed to better understand how adults who are newly introduced to HTPs perceive them relative to cigarettes and e-cigarettes, and the impact of these perceptions on use outcomes. We analyzed 2021 cross-sectional survey data from 1914 adults who never used HTPs from the United States and Israel, two countries where IQOS has unique histories and markets. Exploratory factor analysis examined perceptions of HTPs (vs. cigarettes and e-cigarettes) across 12 perception measures (eg, innovative, trendy, harmful, addictive). Multivariable linear regression examined these factors in relation to self-reported likelihood to: (1) "try HTPs in the next year" (1 = not-7 = extremely) and (2) "suggest IQOS to a friend who smokes cigarettes" (1 = not-5 = very), controlling for demographics and past-month cigarette and e-cigarette use (10.1% dual use, 15.4% cigarette-only, 5.7% e-cigarette-only, 68.8% neither). Four factors were identified: HTPs' health and utility ("health-utility") and design and appeal ("design-appeal") versus cigarettes and versus e-cigarettes, separately. More favorable perceptions of HTP versus e-cigarette design-appeal (B = 0.30, 95% CI = 0.18, 0.41) were associated with greater likelihood to try HTPs. More favorable perceptions of HTP versus cigarette design-appeal (B = 0.38, 95% CI = 0.26, 0.51) and health-utility (B = 0.25, 95% CI = 0.13, 0.36), and HTP versus e-cigarette design-appeal (B = 0.32, 95% CI = 0.20, 0.45) were associated with greater likelihood to suggest HTPs to smokers. Monitoring perceptions of HTPs versus cigarettes and e-cigarettes is critical given the role of such perceptions in HTP use and their population-level impact. This study examined the relationship of perceptions of HTPs relative to cigarettes and e-cigarettes, with regard to adults' self-reported likelihood to use HTP or to suggest HTPs to those who smoke cigarettes. Favorable perceptions of HTPs' design and appeal versus e-cigarettes correlated with greater likelihood to try HTPs. Favorable perceptions of HTPs' design and appeal, as well as health and utility, versus cigarettes and e-cigarettes correlated with greater likelihood to suggest HTPs to those who smoke. Findings underscore the need for ongoing surveillance of HTP marketing and consumer perceptions to inform regulatory efforts and estimate the population-level impact of HTPs and other tobacco products.