Heated Tobacco Product Awareness, Use, and Perceptions in a Sample of Young Adults in the United States

Abstract

Significance The emergence of heated tobacco products (HTPs) in the US marks a critical time for identifying those most likely to use, particularly among young adults. Methods We analyzed Fall 2019 data from a longitudinal study of young adults (ages 18-34; n=2,375, Mage=24.66±4.68) in 6 US cities, 24.1% of whom used cigarettes and 32.7% e-cigarettes. We assessed HTP awareness, use, and sources, as well as perceived risk, social acceptability, and likelihood of future use. Results In this sample, 9.7% (n=230) heard of HTPs, 3.5% (n=84) ever used them, and 2.4% (n=56) reported past-year purchases (tobacco shops, 66.1%; traditional retailers, 60.7%; online, 39.3%; IQOS specialty stores, 35.7%). In multivariable analyses, having heard of HTPs correlated with being older, male, and current cigarette and e-cigarette users; among those ever hearing of them, using HTPs correlated with being non-Hispanic and current cigarette and e-cigarette users. Greater likelihood of future use correlated with being older, male, sexual minority, non-Hispanic, and current cigarette and e-cigarette users. Among past-month users (n=78), the average number of days used was 5.48 (SD=5.54). Past-month cigarette and e-cigarette users, respectively, who tried HTPs were more likely to report consistent or more frequent use of their respective product than a year ago (p’s<.001). HTPs were perceived as less addictive than cigarettes, smokeless tobacco, and e-cigarettes, and less harmful and more socially acceptable than other tobacco products except e-cigarettes and hookah. Conclusions The relatively positive perceptions of HTPs and access via various channels underscores potential penetration of HTPs among US young adults.

Moving targets: how the rapidly changing tobacco and nicotine landscape creates advertising and promotion policy challenges

“…The popularity of ENDS/ENNDS opened market opportunities for HTPs, which contain tobacco heated to temperatures short of combustion to produce tobacco smoke for inhalation 35. Previous heated cigarette products failed due to poor acceptability and inability to deliver on promises of eliminating secondhand smoke,36 but over time devices have become smaller, cheaper and more convenient, and consumers using ENDS are more likely to try HTPs 37 38. Newer generations of HTPs launched in Japan in 201439; in 2021 Japan had the highest number of HTP users in the world40 with Philip Morris International’s (PMI) IQOS leading the market 41 42.…”

Anticipating IQOS market expansion in the United States

“…In July 2020, the FDA authorized that IQOS could be marketed as a 'reduced exposure' product (but denied the request to use 'reduced risk' in marketing, a broader health claim) 7 . In the US, awareness and use of IQOS is low but growing (particularly among current smokers, men, and racial/ethnic minorities) 8,9 . As of 17 May 2021, IQOS had expanded beyond Atlanta, GA, to the following additional markets: Buford, Georgia; Richmond and Tysons, Virginia; North Charlotte and Raleigh, North Carolina; and Charleston and Myrtle Beach, South Carolina 10 .…”

IQOS Marketing in the US: The Need to Study the Impact of FDA Modified Exposure Authorization, Marketing Distribution Channels, and Potential Targeting of Consumers

“…A first step in determining whether this is bearing out is to examine trends in use among those with differing tobacco use histories and among key sociodemographic groups. In the US, current smokers have shown greater HTP use [ 6 , 13 ]. Research in other countries (e.g., Italy [ 69 ], Korea [ 70 ]) indicates mixed findings—some showing that IQOS users are more likely to smoke conventional cigarettes and/or e-cigarettes [ 70 ] and other work showing that never smokers are equally or more likely than current smokers to have already tried or intend to try IQOS [ 69 ].…”

“…Further contradicting the stated target market, a sizeable proportion of US youth and young adults (38.6%) [ 5 ] are interested in IQOS, and relative to older adults, young adults are more likely to use HTPs [ 6 ]. In addition, men and racial/ethnic minorities may be more likely to use HTPs [ 6 , 13 ].…”

“…As of May 2021, IQOS is sold in four states: Georgia (Atlanta, Buford), Virginia (Richmond, Tysons), North Carolina (Charlotte, Raleigh), and South Carolina (Charleston, Myrtle Beach) [ 12 ]. While the use of IQOS in the US is currently low, interest and use are growing [ 5 , 13 ]. Moreover, globally, PM intends to expand its HTP portfolio.…”