Last updated: April 2019
Suggested citation: Greenhalgh, EM. 18C. Heated tobacco (‘heat-not-burn’) products. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2019. Available from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18c-non-combustible-cigarettes/18c-2-extent-of-use
As heated tobacco products cannot be legally sold in Australia (see Section 18C.5), the prevalence of use among Australians is likely extremely low; there are no current estimates available.
Research on awareness and use of heated tobacco products is very limited, although growing. A study in Japan found that in 2015, 0.3% of respondents were current (past month) users of Philip Morris’ iQOS, and 0.3% were current users of Japan Tobacco’s Ploom Tech (respondents could choose multiple products). In 2016, use was similar; however, in 2017, the iQOS current user rate had increased more than 10-fold to 3.6%. The Ploom Tech current user rate increased to 1.2%, and 0.8% were current British American Tobacco Glo users.1, 2 Among all electronic products (Including e-cigarettes) and age groups, current use was highest among 20–29 year old users of iQOS, at 5.8%. About one in five (18.8%) current smokers intending to quit reported current use of iQOS, compared with 10.3% of smokers not intending to quit.2
Two studies recently examined the awareness and use of heated tobacco products among US adults.3, 4 In the first study,3 researchers examined awareness and use between 2016 to 2017 and found that both had increased over time. Adult awareness increased from 9.3% in 2016 to 12.4% in 2017. Ever use of these products increased from 1.4% in 2016 to 2.2% in 2017, and current use more than doubled from 0.5 % in 2016 to 1.1% in 2017. Awareness of heated tobacco products was higher among men than women, and among adults under age 45 than those 45 and older. Non-white adults, cigarette smokers, and both current and former users of electronic nicotine delivery systems had higher rates of heated tobacco product use.
The second study, conducted by researchers from the US Centre for Disease Control, investigated awareness and ever use of heated tobacco products in the US adult population in 2017.4 The findings indicated that 5.2% of adults were aware of heat not burn products, while the prevalence of ever use was 0.7%. The level of awareness differed by gender, age, and smoking status. 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%). Awareness was 5.1% among non-Hispanic whites and 5.6% among other racial groups. Current smokers had the highest awareness of these products (9.9%) followed by never smokers (4.9%) and former smokers (3.7%). The prevalence of use was relatively low, with less than 0.7% reporting ever use. Prevalence of ever use was 0.6% among females and 0.8% amongst men. Ever use among adults under 30 was 1.6% compared to 0.5% in those over 30. Ever use was less prevalent among non-racial Hispanic whites (0.5%) compared to other racial groups (1%). Ever use was 2.7% among current cigarette smokers and 0.5 % among never smokers.
In Korea, a study examined the awareness, experience, and current use of IQOS among young adults.5 Researchers conducted an online survey of 228 adults ages 19-24, three months following the introduction of IQOS in the country in 2017. The study found that while awareness of IQOS was high among survey respondents, use was relatively low. Overall, 38.1% of respondents were aware of IQOS, 5.7% were ever users and 3% were current IQOS users. Current conventional cigarette users were more likely to be aware of IQOS, and to be ever users. All current IQOS users were also users of both conventional cigarettes and e-cigarettes. Current IQOS users attributed their decision to use IQOS to either their belief that the IQOS was less harmful, or because they were attempting to stop smoking.
Awareness and ever use of heated tobacco products were also very rare in England in 2017. Among the 2,185 last year smokers that were surveyed for the Smoking Toolkit Study for that year,6 four reported using heated tobacco products in recent quit attempts, six reported use to help cut down the amount smoked, one reported use in situations where smoking is prohibited, and none reported use for any other reason. Among never and long-term ex-smokers (n=9,777), five said they were using heated tobacco products.
An Italian study found that in 2017, one in five (19.5%) respondents were aware of iQOS (the only available heated tobacco product), 1.4% had tried it and 2.3% intended to try it. One per cent of never smokers, 0.8% of ex-smokers and 3.1% of current cigarette smokers had tried iQOS, while 1.2% of never e-cigarette users, 2.9% of ex-e-cigarette users and 7.7% of current e-cigarette users had tried iQOS.7
1. Tabuchi T, Kiyohara K, Hoshino T, Bekki K, Inaba Y, et al. Awareness and use of electronic cigarettes and heat-not-burn tobacco products in Japan. Addiction, 2015. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26566956
2. Tabuchi T, Gallus S, Shinozaki T, Nakaya T, Kunugita N, et al. Heat-not-burn tobacco product use in Japan: Its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol. Tobacco Control, 2017. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29248896
3. Nyman AL, Weaver SR, Popova L, Pechacek TF, Huang J, et al. Awareness and use of heated tobacco products among US adults, 2016-2017. Tobacco Control, 2018; 27(Suppl 1):s55–s61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30158204
4. Marynak KL, Wang TW, King BA, Agaku IT, Reimels EA, et al. Awareness and ever use of "heat-not-burn" tobacco products among US adults, 2017. American Journal of Preventive Medicine, 2018; 55(4):551–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30033025
5. Kim J, Yu H, Lee S, and Paek YJ. Awareness, experience and prevalence of heated tobacco product, IQOS, among young Korean adults. Tobacco Control, 2018; 27(Suppl 1):s74–s7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30158210
6. McNeill A, Brose L, Calder R, Bauld L, and Robson D, Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England; 2018. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/680964/Evidence_review_of_e-cigarettes_and_heated_tobacco_products_2018.pdf.
7. Liu X, Lugo A, Spizzichino L, Tabuchi T, Pacifici R, et al. Heat-not-burn tobacco products: Concerns from the Italian experience. Tobacco Control, 2019; 28(1):113–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29374094