Use Of Heated Tobacco Products Research Articles

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) vs. 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 1,914 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 (e.g., 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') vs. cigarettes and vs. e-cigarettes, separately. More favorable perceptions of HTP vs. e-cigarette design-appeal (B=0.30, 95%CI=0.18, 0.41) was associated with greater likelihood to try HTPs. More favorable perceptions of HTP vs. 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 vs. 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 vs. 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.

Association between heated tobacco product use and airway obstruction: a single-centre observational study, Japan

BackgroundWhile heated tobacco products (HTPs) may affect pulmonary function, the evidence supporting the utility of screening for HTP use in clinical settings is insufficient. We examined the association between HTP...

Prevalence and reasons for use of heated tobacco products among Malaysian adults who smoked: Findings from the 2020 International Tobacco Control Malaysia Survey

IntroductionThere have been rapid expansions in heated tobacco products (HTPs) outside of Japan and the Republic of Korea. In November 2018, HTPs were first introduced in Malaysia and since then, no studies have been conducted on Malaysians’ use of HTPs. This study is the first to examine the prevalence of HTP use and reasons for use among Malaysian adults who smoked cigarettes. MethodsData came from the 2020 ITC Malaysia Survey, a web-based survey of a nationally representative sample of adults who smoked (n=1047) aged 18 and older. They were asked on ever heard of, ever used, and currently using HTPs, and their reasons for using HTPs. ResultsOverall, 25.4% (n= 324; 95% CI:22.3%−28.7%) of Malaysians who smoked reported ever used HTPs with 6.7% (n=85; 95% CI:22.3%−28.7%) were using them daily and 8.1% (n=110; 95% CI:6.4% −10.2%) were using HTPs non-daily. Most of them (57.2%) who dual use were of aged 25–39 and 97.3% were males. Among those who smoked daily, almost half (49.3%) were also using HTP daily. Among those who used HTPs daily and non-daily, curiosity (84.2%, 95% CI:78.4%−90.0%), taste (83.2%, 95% CI:77.3%−89.1%), and appealing technology (78.5%, 95% CI:71.3%−85.6%) were the most reported reasons. Among those who used HTPs daily, curiosity was the top reason (87.9%, 95% CI:78.9%−93.4%), while among non-daily, taste good was the top reason (81.9%, 95% CI:71.9%−88.8%). ConclusionsThe very high use of HTPs among Malaysians who smoked requires continued public health surveillance that can inform the regulation of these novel tobacco products.

Prevalence, knowledge, and concerns regarding the use of heated tobacco products and electronic cigarettes among young Japanese physicians.

Heated tobacco products (HTPs) and e-cigarettes (ECs) have gained traction as alternatives for harm reduction, especially in Japan. In particular, the use of HTPs is rapidly gaining popularity among young adults in Japan, with a prevalence of 10.9% in 2020. Despite uncertainties regarding the health effects of HTPs and ECs, concerns regarding nicotine and carcinogens persist. Although physicians play a vital role in smoking cessation, they lack awareness and concerns regarding HTPs. This study aimed to assess the prevalence, knowledge, and concerns regarding HTPs and ECs among young Japanese physicians. A cross-sectional online survey was conducted in 2021 with 529 young Japanese physicians aged 24-39 years. Parameters assessed included awareness, smoking status, knowledge of HTPs and ECs, and concerns related to HTPs. Statistical analyses were conducted to assess prevalence, knowledge, and concerns by smoking status using the chi-squared test and logistic regression. Most participants were aware of HTPs (89.0%) and ECs (71.3%). Young male physicians preferred HTPs, while females favored ECs. Primary sources of information included newspapers and stories (56.8%), and TV (37.4%). Non-smokers (89.0%) demonstrated limited knowledge of these products. Concerns were highest and lowest among non-smokers and HTP users, respectively, with safety concerns being the most prevalent. Young physicians exhibited lower smoking rates than the general population, but HTP use was prominent among young male physicians. Concerns varied based on smoking status, indicating the need to address these issues among healthcare professionals. Despite high awareness, knowledge gaps, particularly among non-smokers, highlight the importance of public health and educational campaigns to disseminate knowledge among physicians, regardless of medical specialty.

E-cigarettes and heated tobacco products impact on dental color parameters

ObjectivesAbstaining from tobacco smoking may not only improve general health, but also reduce teeth staining and restore teeth whiteness. Compared with conventional cigarettes, E-cigarettes (ECs) and heated tobacco products (HTPs) may offer substantial reduction in exposure to pigmented tar-like compounds of cigarette smoke. It is possible that improvements in dental color indices may be observed in those who have stopped smoking combustible cigarettes by switching to tar-free nicotine delivery products. MethodsThis cross-sectional study evaluated and compared dental color parameters by digital spectrophotometry among five different groups: individuals who currently smoke ; individuals who used to smoke but have quit ; individuals who have never smoked ; exclusive users of electronic cigarettes (former smokers) ; and exclusive users of heated tobacco products (former smokers) . ResultsDental whiteness in current cigarette smokers was notably worse compared with never and former smokers, (13.38 Whiteness Index for Dentistry (WID) units vs. 19.96 and 16.79 WID units). Remarkably high WID values (i.e., whiter teeth) were also observed in ECs (16.72 WID units) and HTPs users (17.82 WID units). Compared to current smokers, difference in dental whiteness for ECs and HTPs users was visually noticeable (ΔWID difference being on average > 2.90 units). The colour differences measured as delta E*(ΔE*) were all visually detectable except for the comparison between ex-smokers and ECs users for which no perceptible color difference was observed (0.415). ConclusionExclusive use of ECs and HTPs is associated with better dental color measurements than current smoking, suggesting that tar-free nicotine delivery technologies are unlikely to have negative effects on dental appearance. Clinical significanceUse of alternative nicotine delivery systems may be associated with cosmetic benefits with important implications for those smokers perceiving dental aesthetics as a significant problem. For these an oral-based narrative may be a much more significant reason to refrain from smoking than the fear of developing smoking-related diseases in future.

Status of home-based secondhand smoke exposure among children and its association with health risks in Japan

ObjectivesIn Japan, secondhand smoke (SHS) exposure in children has changed with increased heated tobacco products (HTPs) and electronic cigarettes (e-cigs) use. We clarified the status of home-based SHS exposure among children, including HTPs and e-cigs, as well as maternal perceptions on SHS avoidance and examined its association with health risks. MethodsThis cross-sectional questionnaire-survey-based study included 379 mothers who were raising children aged < 5 years. ResultsWe found that 31.1 % of the children had home-based SHS exposure, with widespread HTP and e-cig use among smoking mothers and family members (74.2 % and 67.0 %, respectively). Significantly (p < 0.05), HTP and cigarettes were used in the kitchen and gardens/balconies, and maternal perceptions of child SHS-exposure avoidance were lower among smokers than non-smokers. Non-smoking mothers also had low perceptions of smoking on balconies and having immediate post-smoking contact with their children (27.6 % and 27.9 %, respectively). Most non-smoking mothers (76.4 %) reported that they do not encourage family members to quit smoking. The structural equation model showed that the presence of smoking at home and low maternal perceptions was correlated with SHS-related child health risks, including respiratory diseases, otitis media, and dental caries. ConclusionsHTP and e-cig use in the household has been rapidly increasing even among mothers and family members, and the presence of smokers at home and low maternal perceptions may be associated with child health risks. Increasing the maternal awareness of the child health risks of home-based SHS, including HTPs and e-cigs, along with continued smoking-cessation support involving mothers and families, is indispensable.

Exploring the association between the proximity to and density around schools of retailers selling IQOS products and youth use of heated tobacco products: evidence from the 2020-2021 COMPASS study.

Heated tobacco products (HTPs) are novel tobacco products that may appeal to youth. This study explored whether HTP retailer proximity and density to secondary schools were associated with youth use of HTPs in four Canadian provinces. An online search between November 2020 and March 2021 identified retailers selling IQOS devices and HEETS (tobacco sticks used in IQOS) within 500 m, 1000 m and 1500 m radius circular buffer zones around high schools (N = 120) participating in the COMPASS study in 2020-2021. Retailer proximity/density data were linked to crosssectional student-level data (N = 40 636 students), and multilevel regression models examined the association between HTP retailer proximity and density and current HTP use, controlling for relevant covariates. While only 10.0% of schools had at least one retailer selling IQOS devices within 1000 m of the school, 65.0% of schools had at least one retailer selling HEETS. The school a student attended accounted for 23.7% of the variability in the likelihood of currently using an HTP. However, HTP retailer proximity to and density around schools were not significantly associated with the likelihood of students currently using HTPs. While the school a student attended accounted for a significant amount of variability in HTP use, these findings suggest that students may be obtaining HTPs through other, non-retail sources. Continued monitoring is warranted as HTP use among youth may change.

Respiratory Function, Physical Capacity, and Metabolic Syndrome Components in Combustible Cigarettes and Heated Tobacco Products Users: a Five-Year Follow-Up Cohort Study

Purpose: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and is the fourth leading cause of death in Kazakhstan. Cigarette smoking is a prevalent risk factor for COPD. While quitting smoking is the preferred way to reduce COPD risk, literature suggests that heated tobacco products (HTP) might be a better option for people who cannot quit smoking. The aim of this paper was to analyze the long-term effects of shifting to HTP use in long- term smokers compared to continued combustible cigarettes (CC) use. Patients and methods: A cohort of 1200 participants (393 HTP and 807 CC) aged 40-59 years with a minimum of 10 pack-year smoking history were recruited and followed for five years. The functional outcomes compared between HTP, CC users and No-Smokers (NS, people who stopping smoking) included: (1) COPD Assessment Test (CAT); (2) post-bronchodilator lung function; (3) 6-minute walking distance (6MWD) test; and (4) metabolic syndrome components. Multivariable linear mixed models (MIXED) were used to compare functional outcomes between visits and to test associations between health outcomes and smoking type (HTP vs. CC vs. NS) over time. Results: Out of 1200 participants 830 (466 CC users, 248 HTP users and 116 No-Smokers) remained in the study by the fifth year of follow up. Linear mixed models showed HTP use was associated with better CAT scores and HDL cholesterol level compared to CC users. Lung function (FVC) decrease was significantly less in HTP users. FEV, 6MWD, waist circumference, fasting blood glucose, triglycerides and diastolic blood pressure significantly changes over time, but without between-group difference in dynamic. Conclusion: This study demonstrated that HTP users experienced it to a significantly lesser decrease in lung function by FVC compared to CC users over time (in time dependent model), while demonstrating better stable levels in other functional outcomes. The results of this study suggest that HTP might be a less deleterious alternative compared to CC in people with long history of CC use and who cannot quit smoking.

Why Do Physicians in Japan Use e-Cigarettes and/or Heated Tobacco Products? A Cross-Sectional Survey

Background: The tobacco industry has actively advocated for electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) as harm-reduction alternatives to traditional cigarettes. Around 40% of smoking physicians have adopted HTPs. This study aimed to uncover the motivations behind Japanese physicians’ e-cigarette and HTP use while analyzing the associations between product use, physician demographics, lifestyles, and smoking preferences. Methods: A mail-based survey was conducted in 2020, targeting 6000 male and 1500 female physicians. From the 5492 survey participants, 346 physicians aged 28 to 98 who were current smokers were selected. The survey assessed their usage of e-cigarettes and HTPs and explored the reasons for initial adoption. A multivariate logistic regression analysis examined the relationships between product use, physician characteristics, and behaviors. Results: Approximately 33.8% of smoking physicians had experimented with e-cigarettes and HTPs. E-cigarette and HTP use correlated with youthfulness, nicotine addiction, and a history of medical treatment. The primary drivers for adopting e-cigarettes and HTPs were reduced odor (74.4%), perceived harm reduction (48.7%), and decreased exposure to secondhand smoke (29.1%). Conclusions: Physicians, when transitioning from conventional cigarettes to HTPs or e-cigarettes, are primarily motivated by a desire to reduce the odor of conventional cigarettes rather than health-related concerns.

Effect of Electronic Cigarette and Heated Tobacco Product Use on Smoking Cessation Plans among Korean Adults: The 8th Korea National Health and Nutrition Examination Survey (2019–2020)

Effect of Electronic Cigarette and Heated Tobacco Product Use on Smoking Cessation Plans among Korean Adults: The 8th Korea National Health and Nutrition Examination Survey (2019–2020)

Examining acute psychopharmacological effects of nicotine vaping versus heated tobacco products in a randomised crossover study of product naïve adult smokers

Nicotine vaping products (NVPs) and heated tobacco products (HTPs) are designed to replicate the sensory and behavioural aspects of smoking cigarettes while avoiding combustion. The success of these products as harm reduction tools will partially depend on their ability to satisfy smokers and alleviate nicotine-related withdrawal symptoms. This study aims to compare short-term effects of NVPs (Juul and Aspire PockeX) versus HTPs (IQOS) on smoking-related withdrawal relief, product satisfaction, intention to switch to NVP/HTP, perceptions and attitudes in UK adult cigarette smokers naïve to these products. In a randomized cross-over study, 45 participants visited the lab twice, at each visit trying one of the two products (NVP/HTP) and completing a questionnaire. Responses were normalized on a 0–100% scale and mean differences (MD) between NVP and HTP scores computed, with positive and negative MD values indicating greater endorsement for NVP and HTP, respectively. Cigarette cravings were reduced similarly (~ 20.0%) by both products (MD = 4.5%, 95%Confidence Interval (CI) − 4.8, 13.8). Direct positive effects (MD = − 3.5%, 95%CI − 7.2, 0.2) and adverse side effects (MD = 1.8%, 95%CI − 0.3, 3.8) were comparable after each product use, though marginally favouring HTPs. HTPs were perceived as more satisfying overall (MD = − 13.2%, 95%CI − 20.3 − 6.1) than NVPs but both were perceived as similarly addictive (MD = 3.6%, 95%CI − 4.6, 11.8), relative to cigarettes. Intention to switch to either product was comparable (MD = 4.0%, 95%CI − 5.7, 13.8). Comparison of acute use of NVP versus HTP in a sample of UK smokers naïve to these products suggests that HTPs are perceived as more satisfying than NVPs, though still less satisfying than cigarettes.Registration: The analysis plan was pre-registered, and it is available at https://osf.io/6ymdu

Comparing identity, attitudes, and indicators of effectiveness in people who smoke, vape or use heated tobacco products: A cross-sectional study

BackgroundThere is limited long-term and independent research on heated tobacco products (HTPs). We compared people who used HTPs with those who used nicotine vaping products (NVP) or cigarettes on smoker identity, indicators of effectiveness and, among NVP/HTP users, perceptions of these products. MethodsAdults exclusive cigarette smokers (N = 45) and ex-smokers with medium/long-term (>3months) NVP (N = 46) or HTP use (N = 45) were recruited in London, UK. Participants completed a questionnaire assessing socio-demographics, smoking characteristics, smoker identity, dependence, intention to stop and attitudes towards HTP/NVP. ResultsIn adjusted analysis, people who used cigarettes (Mean Difference (MD) = 1.4, 95%Confidence Intervals (CI) 0.7,2.0) and HTPs (MD = 0.8, 95%CI 0.1, 1.5) reported stronger smoker identities than those who used NVPs. Compared with smokers, HTP/NVP users had lower cravings for cigarettes (MD = 3.0, 95%CI 1.6, 4.3; MD = 3.1, 95%CI 1.9, 4.3, respectively), and higher intention to stop product use (MD = −0.8, 95%CI −1.7,-0.01; MD = −1.2, 95%CI −2.0, -0.3, respectively). People using HTPs or NVPs reported similar perceived product satisfaction (HTP:M = 3.4, 95%CI 2.8, 3.9; NVP:M = 3.0, 95%CI 2.5, 3.5), efficacy for smoking cessation (HTP:M = 4.5, 95%CI 4.2, 4.9; NVP:M = 4.6, 95%CI 4.3, 4.9) and safety (HTP:M = 2.1, 95%CI 2.0, 2.2; NVP:M = 2.0, 95%CI 1.8, 2.1). HTP users reported greater perceived addictiveness than NVPs (MD = 0.3, 95%CI 0.2, 0.6). ConclusionsHTP and NVP users perceived products to be similarly acceptable and effective suggesting that HTPs, like NVPs, may support smoking cessation. However, since HTP use appears to maintain a stronger smoker identity and perceived addiction, this may suggest a more limited role of HTP for a permanent transition away from cigarettes.

Health warning labels on heated tobacco products and their impact on use intentions and risk perceptions: a cross-sectional study of adult tobacco users in the US and Israel.

Health warning labels (HWLs) represent an evidence-based tobacco control strategy; however, their application to heated tobacco products (HTPs) and related impacts are understudied. This study examined the impact of HTP HWLs on HTP use intentions and risk perceptions among current tobacco users. We analyzed cross-sectional survey data from adults in the US and Israel reporting past-month tobacco use and awareness of HTPs (N = 424). Multivariate analyses examined: (1) sociodemographics in relation to self-reported impact of HTP HWLs (i.e., more concerned about HTP use, reassured, no effect [referent]) among those who noticed HTP HWLs (multinomial regressions); and (2) HWL impacts in relation to HTP use intentions and perceived addictiveness and harm (linear regressions). Among participants who noticed HTP HWLs (n = 372, 87.7%), 27.7% reported HWLs increased their concerns about HTP use, 22.6% were reassured about use, and 49.7% reported no effect. Factors associated with increased concern (vs. no effect) included other tobacco product use (aOR = 2.10, 95% CI 1.21-3.64) and being female (aOR = 1.77, 95% CI 1.03-3.05). Factors associated with being reassured about HTPs use (vs. no effect) included current HTP use (aOR = 2.11, 95% CI 1.11-4.00) and being from Israel (vs. US: aOR = 3.85, 95% CI 1.85-7.69), female (aOR = 1.91, 95% CI 1.07-3.42), and less educated (< college education: aOR = 2.57, 95% CI 1.42-4.63). Reporting that HWLs on HTPs increased concern (β = 0.46, 95% CI 0.03-0.89) and reassured of use (β = 0.94, 95% CI 0.47-1.41) were positively associated with HTP use intentions; no associations with risk perceptions were found. Findings indicate that most tobacco users noticed HWLs on HTPs, but the majority reported no effect or being reassured of using HTPs, effects that were magnified for specific subgroups. Both increased concern and reassurance correlated with greater use intentions. Additional research should evaluate HTP HWL impacts and ensure effectiveness in communicating risks and discouraging use.

Relationship between heated tobacco product use and allergic rhinitis in Korean adults.

Combustible cigarette (CC) smoking is a risk factor for chronic obstructive pulmonary disease (COPD) and asthma, and some studies reported that tobacco smoking might affect the development or symptom control of allergic rhinitis, sinusitis, and atopic dermatitis. However, evidence on the health risks of heated tobacco products (HTPs) is lacking. We investigated the prevalence of respiratory and allergic diseases according to tobacco use types in Korean adults. We used data from 18230 adults in the Korea National Health and Nutrition Examination Survey. Multiple logistic regression analyses were performed to assess the prevalence of respiratory and allergic diseases according to tobacco use types (current exclusive CC use, current exclusive HTPs use, and dual use of CC and HTPs). The prevalence of exclusive CC users, exclusive HTPs users, dual users of CC and HTPs was 15% (n=2740), 1% (n=182), and 2.4% (n=435), respectively. The prevalence of COPD was higher among past tobacco users (AOR=2.37; 95% CI: 1.02-5.51) versus no tobacco use group. The prevalence of asthma was higher among past tobacco users or exclusive CC users (AOR=1.73; 95% CI: 1.26-2.38, and AOR=1.57; 95% CI: 1.08-2.26) versus non-users of tobacco. The prevalence of allergic rhinitis was higher among past tobacco users versus non-users of tobacco (AOR=1.33; 95% CI: 1.13-1.57), and the prevalence of allergic rhinitis was higher among exclusive HTPs users versus non-users of tobacco or exclusive CC users (AOR=1.60; 95% CI: 1.06-2.42, and AOR=1.74; 95% CI: 1.14-2.66). The adjusted odds of sinusitis and atopic dermatitis were not significantly different between tobacco use types. Exclusive use of HTPs was associated with allergic rhinitis in Korean adults. Further longitudinal studies are needed to clarify the health risk of HTPs.

Association of cigarette smoking with increased use of heated tobacco products in middle-aged and older adults with self-reported chronic obstructive pulmonary disease, asthma, and asthma-COPD overlap in Japan, 2022: the JASTIS study

BackgroundSmoking cessation is the most important intervention in chronic obstructive pulmonary disease (COPD), asthma, and asthma-COPD overlap (ACO); however, high rates of current cigarette smoking are observed in adults with these respiratory diseases. Meanwhile, rapidly increasing use of heated tobacco products (HTPs) is observed in Japan; however, the status of HTPs use has not been fully understood in adults with COPD, asthma, and ACO. This study aimed to reveal the association between COPD, asthma, and ACO and HTPs use in adults.MethodsData on Japanese individuals ≥ 40 years old obtained from the Japan Society and New Tobacco Internet Survey were analyzed. The prevalence of HTPs use in adults with COPD, asthma, and ACO, among individuals categorized into three groups according to cigarette smoking (never, former, and current), was calculated and the relationship between each disease and HTPs use were evaluated. The clinical diagnosis of these diseases was based on the self-reported diagnosis, as obtained from questionnaires.ResultsA total of 19,308 individuals were included. The proportions of never, past, and current cigarettes smokers were 10,900 (56.5%), 4,903 (25.4%), and 3,505 (18.2%), respectively, and that of HTPs use was 1,813 (9.4%). In current cigarettes smokers, the adjusted odds ratios (ORs) of HTPs use was 2.88 (95% CI [confidence interval], 1.86–4.47), 1.23 (95% CI, 0.99–1.52), and 5.81 (95% CI, 3.12–10.82) in adults with COPD, asthma, and ACO compared to those without these respiratory diseases, respectively. Meanwhile, in past cigarettes smokers, the adjusted ORs of HTPs use was 0.51 (95% CI, 0.24–1.08), 0.69 (95% CI, 0.53–0.88), and 0.25 (95% CI, 0.06–1.07) in adults with COPD, asthma, and ACO, respectively.ConclusionsHTPs use is more prevalent among current cigarettes smokers with COPD, asthma, and ACO compared to those without these respiratory diseases. Complete cessation of smoking both cigarettes and HTPs is the only way to achieve complete smoking cessation, therefore, adults with COPD, asthma, and ACO need to make greater efforts to quit smoking.

Awareness, Attitudes, and Concerns Regarding Heated Tobacco Products among Physicians in Japan.

New tobacco products, particularly heated tobacco products (HTPs), have been introduced across several international markets as alternatives to combustible products, such as cigarettes. However, there are limited studies on physicians' perceptions of HTPs. This study analyzes the awareness of HTPs among physicians and assesses their concerns and attitudes toward patients using HTPs. A self-administered questionnaire was sent to a sample of 7,500 member physicians (6,000 male and 1,500 female) from the Japan Medical Association (JMA). The smoking status of physicians was categorized as never smokers, ever HTP smokers, current HTP smokers, and ever and current smokers of other products. Physicians' awareness and attitudes toward patients using HTPs were analyzed using descriptive statistics. The correlation between the outcomes was examined using logistic regression models, whereas physicians' concerns about HTPs were analyzed using descriptive statistics. Data were obtained from 5,492 physicians (21.9% women; aged 60.4±12.1 years) with a response rate of 74.6%. Overall, 76.7% of the physicians had awareness of HTP, and about half of whom asked patients about using HTPs. Physicians who took longer to discuss cessation were more likely to discourage patient use. Smoking status was associated with discouraging HTP use in patients. Physicians who had experience with HTP use were primarily concerned about the products' long-term safety and less about product regulation. Japanese physicians do not have sufficient information and knowledge about HTPs. Therefore, evidence-based guidelines are required to support physicians in advising patients against HTP use.

Utilization of electronic nicotine delivery systems, heated tobacco products among Vietnamese students: a multivariate analysis of knowledge, attitudes, and behaviors

Objective: This study aims to describe the knowledge, attitudes, and behaviors of using electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs), and related factors among high school students in four provinces (including Hanoi, Hai Phong, Quang Ninh, and Can Tho) in the year 2022. Method: A cross-sectional quantitative study with analysis was conducted on 1,043 high school students in the four provinces through questionnaires. Results: Approximately 27% and 81% of the students demonstrated adequate knowledge and positive attitudes towards ENDS, and HTPs, respectively. The prevalence of students who smoked ENDS and/or HTPs in the past month was 4%, with the highest rate observed in Hanoi (roughly 12%). Factors associated with knowledge, attitudes, and smoking behavior included their province/city of residence, exposure to information, gender, academic grade, and having friends who smoke. Conclusion: It is crucial to implement strategies that enhance accurate knowledge among students and strengthen the regulation of the purchase and use of ENDS and HTPs in the market in order to mitigate tobacco use behaviors among adolescents. Keywords: High school students, electronic nicotine delivery systems, electronic cigarettes, heated tobacco products, new generation tobacco products, influencing factors