Research examining awareness and use of heated tobacco products has primarily been conducted in countries with the largest markets (see Section 18B.2). To date, there is very little research on Australians’ perceptions of the products or prevalence of use.
18B.4.1 Awareness of heated tobacco products
Despite not being legally sold in Australia, more than one in four (27.4%) Australian respondents to the 2018 ITC Four Country Smoking and Vaping Survey were aware of heated tobacco products. 1
Research examining awareness of heated tobacco products among US adults between 2016 to 2017 found that it had increased from 9.3% in 2016 to 12.4% in 2017. 2 Research from the US Centre for Disease Control in 2017 indicated that 5.2% of adults were aware of heated tobacco products. Awareness was higher in males (7%) than females (3.7%) and among adults 30 years and under (7.6%) than adults over 30 years of age (4.6%). People who currently smoked had the highest awareness of these products (9.9%) followed by those who had never smoked (4.9%) and formerly smoked (3.7%). 3 In 2020, about 15% of the adult US population reported being aware of heated tobacco products. 4 Among US teenagers, awareness of heated tobacco products increased 51% during 2019-2020, from 12.8% to 19.3%. 5
In Korea, a survey of young adults conducted three months following the introduction of IQOS in 2017 found that 38.1% of respondents were aware of IQOS. Current conventional cigarette users were more likely to be aware of IQOS. 6
An Italian study found that in 2017, one in five (19.5%) respondents were aware of IQOS (the only available heated tobacco product). 7
18B.4.2 Perceptions of heated tobacco products
Although frequently marketed as a less harmful alternative to smoking (see Section 18B.3), perceptions of heated tobacco products vary and many people express uncertainty about health risks. 8 , 9 Users of heated tobacco products generally report more favourable perceptions regarding their harmfulness and addictiveness, and are less supportive of regulations on the products. 10 , 11 Research in Hong Kong and Korea has found generally negative perceptions of heated tobacco products, with most people perceiving them as more harmful than cigarettes, and as ineffective for quitting cigarettes. 12 , 13 In Hong Kong, support for regulations such as bans on use in smokefree areas and on sales to minors was generally high, although lower among those with favourable perceptions of the products. 12 A survey in Hungary of heated tobacco product users found that the large majority (87%) perceived them as less harmful than cigarettes—more than the proportion that perceived nicotine replacement therapy (80%) and e-cigarettes (45%) as less harmful than smoking. 14
In the US, surveys of young adults have found that heated tobacco products were perceived as less harmful and addictive than cigarettes and e-cigarettes, 15 and as more socially acceptable than cigarettes. 15 , 16 Those who perceived IQOS as fashionable and an e-cigarette substitute were more likely to have ever used or have intentions to use heated tobacco products. 17 Research in Japan found that among non-tobacco users, being male, aged under 39 years, and lower education were associated with a perception of heated tobacco products as less harmful. 18 Among people who smoke, another survey in Japan found that about half perceived heated tobacco products as being less harmful than cigarettes. 9
18B.4.3 Prevalence of use of heated tobacco products
18B.4.3.1 Prevalence of use in Australia
Results from the 2018 International Tobacco Control (ITC) survey of people who are current and former smokers and/or users of vaping products showed that 0.9% of Australian respondents had tried heated tobacco products, and 0.2% reported current use. 1 Findings from the 2022–2023 National Drug Strategy Household Survey showed that 0.7% of Australians aged 14+ reported use of heated tobacco products. Among people who smoke, 2.6% reported use, compared with 0.5% of people who do not smoke. 19
18B.4.3.2 International prevalence of use
A systematic review of the global prevalence of heated tobacco product use found that the global pooled prevalence of ever, current and daily use in 2015–2022 was 4.87, 1.53 and 0.79%, respectively. Prevalence of daily use was less than 2% for most countries, except for Czech Republic, Cyprus, Italy, Poland and Slovakia. 20 A study examining heated tobacco product use in Europe in 2020 found that ever use ranged from 2.8% in France to 14.6% in the Czech Republic, with seven countries reporting prevalence above 10%. The countries with the lowest prevalence of current and daily use were Denmark (0.3% and 0.1%, respectively) and Sweden (0.4% and 0.1%), while those with the highest prevalence were Czech Republic (3.1% current and 2.5% daily use) and Cyprus (3.1% and 2.3%, respectively). 21
Japan is the largest market for heated tobacco products—see Section 18B.2—and use has increased rapidly since the products were introduced in the mid-2010s. 22 The most recent national prevalence estimates are from 2017 and 2018, which researchers note may now be outdated with the large growth in this market in recent years. 20 In 2018, 14.1% of adult men and 3.7% of adult women reported ever use of heated tobacco products, while 8.3% of men and 1.9% of women reported current use. 23 A large internet-based survey in 2022 reported current use of heated tobacco products at 11.8%. 24 Among adolescents, in 2017, 0.5% of junior high school students, and 0.9% of high school students reported current use of heated tobacco. 25
South Korea has the second-largest heated tobacco product market after Japan. In 2019, the prevalence of heated tobacco product use in men and women aged 19 years or older in South Korea was 8.8% and 1.5%, respectively. The proportions of single, dual, and triple users of the products were 23.6%, 58.0%, and 18.4%, respectively. 26 Among adolescents, 4.7% reported current use. 20
In the US, 2.2% of adults reported having ever used heated tobacco products in 2020. 4 In 2021, 0.8% of high school students and 0.4% of middle school students reported current use of heated tobacco products. 27 In the UK, 6.6% of adults in 2020 reported ever use of heated tobacco, and 0.9% reported current use. 21 Among adolescents, 1.3% reported ever use and 0.5% reported current use of heated tobacco products in 2020. 28
Relevant news and research
For recent news items and research on this topic, click here. (Last updated December 2024)
References
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