Use of IQOSTM (a heated tobacco product) in Italy: A cross-sectional survey

Abstract

Background: Limited data are available on the use of heated tobacco products (HTPs) and specifically the use of IQOS™ in Italy. Here, we present the results of a cross-sectional survey on a randomly selected sample of registered of IQOS™ legal age users with the aim of assessing their use behaviors associated with IQOS™ and previous tobacco use history to better understand patterns of IQOS™ use at individual and population levels in Italy. Methods: A quantitative survey on 3002 interviews was conducted from May 20 to May 26, 2020, on a sample of IQOS™ users of both sexes, aged 18-80 years and who had used at least 100 tobacco units (HEETSTM) in their lifetime. Results: The mean age at the time of starting using IQOSTM was 36.3 years. Only 0.8% had started regularly (at least 1 HEETSTM per day) using IQOS™ at 16-<18 years, whereas the majority started at 25-44 years (52.5%). For 64% of respondents, IQOS™ was their exclusive tobacco product, whereas 36% used IQOS™ in combination with another tobacco and/or nicotine product (TNP) (mainly IQOS™ and cigarettes: 25%). Ninety percent of IQOS™ users were cigarette smokers (89.7%) or e-cigarette users (0.3%) at the time when they started using IQOS™. Only 0.6% had never smoked, and 8.3% were former cigarette smokers or e-cigarette users when they started to use IQOS™. Conclusions: The vast majority of respondents were already smokers when they switched to IQOS™, suggesting that the product does not pose a strong risk of attracting nicotine-naïve users. Further, most IQOS™ users in this survey reported they no longer smoke cigarettes. Our findings indicate that the use of alternative TNPs has the potential to reduce the number of cigarette smokers in Italy.