Prevalence and reasons for use of Heated Tobacco Products (HTP) in Europe: an analysis of Eurobarometer data in 28 countries

Abstract

Background Heated Tobacco Products (HTP) are a relatively new class of tobacco products, with limited data on usage patterns. We assessed the prevalence and reasons for use among persons aged ≥15 years in 27 European Union member states and the United Kingdom· Methods The 2020 Eurobarometer (93·2) survey was analysed (n=28,300, aged ≥15). Multi-level regression analyses assessed socio-demographic differences in use while separate analyses investigated reasons for starting to use HTP. Results are presented as adjusted Odds Ratios (aOR) and weighted percentages with 95% Confidence Intervals (95%CI). Findings Overall, 6·5% (95% CI 6·1;7·0) of participants had ever used a HTP. 1·3% (1·1%;1·5%) of participants were current users of HTP, and 0·7% (0·6% to 0·9%) daily users. Current and former tobacco smokers were more likely than never tobacco smokers to use HTP (aOR 36·3 (22·9;57·5), and 7·3 (4·3;12·3) respectively. Youth aged 15-24 years of age were substantially more likely to report use, e.g. aOR for ever use=7·77 (6·56;9·21) compared to those aged ≥55 years. 51·3% of ever HTP users reported at least weekly concurrent use of combustible tobacco. Among those who reported ever use of HTP, but not e-cigarettes, the most popular reason for use was the perception that HTP are less harmful than smoking tobacco (39·5%), followed by use by friends (28·4%) and stopping or reducing smoking (28·2%). Interpretation Considerable numbers of people in the EU have ever used HTP, although current and daily use remains low. Current use is more common among younger people, and current and former smokers. Funding None

How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries

“…Our analyses were also limited by the fact that the Eurobarometer questionnaire did not distinguish between ECs and HTP and did not assess quitting attempts among people concurrently using cigarettes (dual users). Considering that many of the users of novel products also smoke cigarettes, 30 our findings may not be generalisable to all users of ECs and HTP. Separating HTP and ECs in survey questions and assessing in detail dual and polyusers are becoming increasingly essential considering their popularity.…”

European Tobacco Products Directive (TPD): current impact and future steps

“…The need for such a fast turnaround and assessment of new 'variants of interest' is especially evident in light of the swift expansion of JUUL in the USA and the launch and proliferation of HTPs. [8][9][10][11] However, for its maximum potential to be reached, the issue of on March…”

“…30 Despite this notable drop in prevalence, the differential regulation of cigarettes and RYO tobacco compared with other smoked products (ie, cigarillos) and other products, such as e-cigarettes and HTPs, created inconsistencies concerning packaging, labelling, and flavouring and may have led to product displacement rather than a reduction in consumption, particularly among youth. 9 Cohort study research has indicated that the implementation of the TPD had altered smoking behaviour through changes in consumption patterns 37 38 but may also have led to product switching or displacement, which may partially explain some of the differences in prevalence for specific product categories. 39 40…”

“…The EU-CEG, while highly complex and challenging to use in day-to-day regulatory work at the EU MS level, is an exceptional monitoring tool as it may allow EU MS to swiftly respond to product evolutions or upcoming ‘outbreaks’ of newly evolved tobacco products or ‘variants of interest’ across the EU MS markets as they emerge. The need for such a fast turnaround and assessment of new ‘variants of interest’ is especially evident in light of the swift expansion of JUUL in the USA and the launch and proliferation of HTPs 8–11. However, for its maximum potential to be reached, the issue of ensuring sustainable staff capacity working on tobacco control in the EU MS would need to be addressed.…”

“…On the contrary to e-cigarettes which had already emerged before the TPD, HTPs had not launched during the drafting of the legislation, leading to them being covered under a more general blanket of ‘novel tobacco products’. As, however, their use has expanded over the years, predominantly among youth,9 11 30 more comprehensive regulation may be needed. HTPs, although required to have their ingredients and emissions reported to regulators via the EU-CEG, they were exempted from the ban on characterising flavours.…”