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Cruz-Jiménez L, Barrientos-Gutiérrez I, Vidaña-Pérez D, Gallegos-Carrillo K, Arillo-Santillán E, Rodríguez-Bolaños R, Hardin JW, Kim M, Thrasher JF. Heated tobacco product use frequency, smoking quit attempts, and smoking reduction among Mexican adult smokers. Tob Induc Dis 2024; 22:TID-22-90. [PMID: 38813582 PMCID: PMC11135162 DOI: 10.18332/tid/187576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Heated tobacco products (HTPs) are promoted as less harmful than cigarettes; nonetheless, whether HTPs help smokers quit is uncertain. METHODS Data from 4067 Mexican adult smokers surveyed longitudinally every four months (November 2019-March 2021) were analyzed. Mixed-effects multinomial models regressed HTP use frequency (no use=reference; monthly; weekly; and daily use) on sociodemographics and tobacco/nicotine-related variables. Among participants who completed at least two surveys (n=2900) over four months, the duration of their longest smoking quit attempt (SQA) between surveys (SQAs: <30 days; ≥30 days; no SQA=reference) was regressed on HTP use frequency, and changes in the number of cigarettes smoked per day were regressed on HTP initiation between surveys, adjusting for covariates. RESULTS Consistent predictors of all HTP use frequencies (monthly, weekly, or daily vs no use) were daily smoking >5 cigarettes (ARRR=1.69 [95% CI: 1.12-2.55], 1.88 [95% CI: 1.26-2.81] and 6.46 [95% CI: 3.33-12.52], respectively); e-cigarette use (ARRR =5.68 [95% CI: 3.38-9.53], 6.54 [95% CI: 4.06-10.55] and 2.59 [95% CI: 1.26-5.30]); lower HTP risk perceptions (ARRR=2.12 [95% CI: 1.50-30.00], 2.25 [95% CI: 1.63-3.10] and 2.00 [95% CI: 1.25-3.22]); exposure to HTP information inside (ARRR=2.13 [95% CI: 1.44-3.15], 2.13 [95% CI: 1.49-3.05] and 3.72 [95% CI: 2.28-6.09]) and outside stores (ARRR=2.36 [95% CI: 1.56-3.57], 2.32 [95% CI: 1.65-3.25] and 2.44 [95% CI: 1.41-4.24]) where tobacco is sold; having family (ARRR=2.46 [95% CI: 1.54-3.91], 2.90 [95% CI: 1.93-4.37] and 2.96 [95% CI: 1.52-5.77]) and friends (ARRR=5.78 [95% CI: 3.60-9.30], 4.98 [95% CI: 3.22-7.72] and 6.61 [95% CI: 2.91-15.01]) who use HTPs. HTP use frequency was not associated with quit attempts, except for monthly HTP use predicting SQAs lasting ≥30 days (ARRR=2.12 [95% CI: 1.17-3.85]). Initiation of HTP use was not associated with changes in smoking frequency. Limiting analysis to those who intend to quit smoking also yielded null results. CONCLUSIONS Among Mexican adult smokers, frequency of HTP use was mostly not associated with either cessation behaviors or changes in cigarette consumption, suggesting that HTPs have limited to no effectiveness for smoking cessation.
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Affiliation(s)
- Lizeth Cruz-Jiménez
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | | | - Dèsirée Vidaña-Pérez
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Katia Gallegos-Carrillo
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Mexico
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Mexico
| | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - James W. Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - Minji Kim
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
| | - James F. Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, United States
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
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Dera P, Klimiuk K, Kalinowska-Beszczyńska O, Balwicki Ł. Digital smoke signals: Event-driven online search trends in Heated Tobacco Products in Poland. Tob Prev Cessat 2024; 22:TPC-10-22. [PMID: 38784155 PMCID: PMC11112517 DOI: 10.18332/tpc/187280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Heated tobacco products (HTPs) have emerged as a prominent category in the tobacco market, particularly within European countries such as Poland. The introduction of HTPs has been met with increasing public interest, reflected in online search behavior. However, the public health implications of this new form of tobacco consumption remain a concern due to the lack of comprehensive research on its long-term effects. This study aimed to track the trends in online searches related to HTPs in Poland between 2016 and 2022, and to assess the impact of significant events on these trends in order to provide insights into public awareness of HTPs. METHODS Utilizing Google Trends, a free source tool, this study analyzed relative search volume (RSV) for HTP-related keywords in Poland. Key events were identified and mapped against the fluctuations in RSV to understand their impact on search behavior. The analysis was confined to specific HTP-related keywords, excluding broader tobacco-related terms. RESULTS A notable increase in HTP-related search queries was observed, particularly around the time of product launches and legislative changes. The largest increases occurred during the introduction of HTPs to the Polish market and during major events such as the COVID-19 pandemic. CONCLUSIONS The study demonstrates a market interest in HTPs among Polish internet users, with search trends influenced by product launches and policy changes. The findings highlight the importance of monitoring online behaviors to inform public health efforts, despite limitations such as the lack of demographic data. Further research is needed to deepen the understanding of how these online trends correlate with actual consumer behavior and product sales.
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Affiliation(s)
- Paulina Dera
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Klimiuk
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | | | - Łukasz Balwicki
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
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Irshad HA, Jehanzeb H, Raja S, Saleem U, Shaikh WA, Shahzad A, Amirali A, Iqbal N, Khan JA. Heated tobacco products- well known or well understood? A national cross-sectional study on knowledge, attitudes and usage in Pakistan. BMC Public Health 2024; 24:1328. [PMID: 38755586 PMCID: PMC11100178 DOI: 10.1186/s12889-024-18825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Heated tobacco products (HTPs) are reshaping the tobacco industry and just recently, a plan was sought to regularize HTPs in Pakistan. Pakistan provides an intriguing case study in this context, as tobacco use is deeply ingrained in public use. To ensure that future evidence-based policy recommendations are grounded in the public's knowledge, attitudes, and usage of HTPs, a nationwide survey must be conducted. METHODS A cross-sectional study was conducted using an online-based questionnaire nationwide in Pakistan. The questionnaire was validated and distributed through convenience sampling. The questionnaire assessed participants' knowledge, attitudes, and usage of HTPs. Descriptive statistics was used to describe participants' response and linear regression was performed at a p-value of < 0.05 using SPSS version 26. RESULTS In our sample of 1195 respondents (mean age of 33 years, 41.8% males and 58.2% females), 54.7% had previously heard about HTPs and 16.9% reported using HTPs at least once. Additionally, 38.24% were unsure of the legality of HTP use. Those with monthly household incomes of PKR 100,000 to 500,000, were more likely to have higher knowledge scores (OR:1.80[1.07-3.04]). On the other hand, males (OR:0.70 [0.55-0.89]) and respondents from Balochistan (OR:0.40 [0.22-0.71]) were more likely to have lower knowledge scores. The strongest motivators were the enjoyability of HTPs (55.73%) and usage as a cigarette alternative (54.64%), while the strongest deterrents were the negative health effects (82.68%) and potential for addiction (81.01%). CONCLUSION Our study underscores the need for awareness campaigns and interventions concerning HTPs, given prevalent preconceived notions and mixed attitudes among respondents. It was found that women and households with higher incomes scored higher on knowledge. Subjective enjoyment and a substitute for cigarettes were important motivators, but the most mentioned deterrents were the possibility of addiction and the detrimental effects on health. These insights form the basis for informed policy making for non-cigarette tobacco products.
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Affiliation(s)
| | - Hamzah Jehanzeb
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Sajjan Raja
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Umair Saleem
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | | | - Akmal Shahzad
- Medical College, Aga Khan University, Karachi, 74800, Pakistan
| | - Atiqa Amirali
- Jinnah Medical and Dental College, Karachi, 74800, Pakistan
| | - Nousheen Iqbal
- Jinnah Medical and Dental College, Karachi, 74800, Pakistan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, 74800, Pakistan
| | - Javaid Ahmed Khan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, 74800, Pakistan.
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Andreas S, Chen DTH, Grigg J, Filippidis FT. [European Respiratory Society statement on novel nicotine and tobacco products, their role in tobacco control and "harm reduction"]. Pneumologie 2024. [PMID: 38670147 DOI: 10.1055/a-2298-8015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
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Suzuki H, Aono N, Zhang Y, Yuri K, Bassole Epse Brou MAM, Takemura S, Higashiyama A, Tabuchi T, Fujiyoshi A. Comparison of Publications on Heated Tobacco Products With Conventional Cigarettes and Implied Desirability of the Products According to Tobacco Industry Affiliation: A Systematic Review. Nicotine Tob Res 2024; 26:520-526. [PMID: 37950902 DOI: 10.1093/ntr/ntad205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/01/2023] [Accepted: 10/01/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Heated tobacco products (HTPs) have been advertised as "reduced-harm" tobacco products compared to conventional cigarettes (CC); however, no direct evidence supporting HTPs being desirable for human health exists. A previous systematic review reported that evidence on HTPs published in 2017 or earlier was primarily drawn from industry-related papers. We aimed to investigate whether tobacco industry-affiliated studies are more likely to conclude that HTPs are more desirable than CC. METHODS PubMed and Ichushi-Web were searched up to March 15, 2022, for studies on HTPs published in 2017 or after. We selected studies that assessed any measures of HTPs and CC, including secondary analyses using gray literature in English or Japanese. We excluded review articles except for a meta-analysis that met the aforementioned criteria. Data on the authors' affiliations, grant, conflict of interest, category of research subjects, and interpretation were extracted. Research members in two groups independently assessed the papers; discrepancies were solved by discussion between the groups. RESULTS Overall, 134 studies met the criteria. Eighty-seven (64.9%) of them were affiliated with the tobacco industry. Of the 134 studies, 56.3% (49/87) of the industry-affiliated studies versus 19.1% (9/47) of nonindustry-affiliated studies concluded that HTPs were more desirable than CC (p < .01). No study investigated clinically relevant outcomes, such as disease occurrence. CONCLUSIONS Publications on HTPs in the biomedical literature from January 2017 to March 2022 were dominated by tobacco industry-affiliated studies. More than half of them concluded that HTPs were more desirable than CC compared to independent studies. IMPLICATIONS Tobacco industry advertises HTPs as "reduced-harm" tobacco products compared to CC. HTP users tend to consider HTPs as alternative tobacco products less harmful than CC (ie, products for "harm reduction"). Our results demonstrated that papers written by tobacco industry-affiliated authors concluded that HTPs were more desirable than CC compared to papers by independent authors. However, all their judgments were based on surrogate outcomes. Surrogate outcomes are not necessarily linked to clinically relevant outcomes such as disease occurrence. Further studies on HTPs using clinically relevant outcomes are warranted by independent authors from tobacco industry.
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Affiliation(s)
- Harumitsu Suzuki
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Naoki Aono
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Yan Zhang
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Kuniko Yuri
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | | | - Shigeki Takemura
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Aya Higashiyama
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Fujiyoshi
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
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Lee S, Xu SS, Yan M, Gravely S, Quah ACK, Seo HG, Lim S, Cho SI, Kim Y, Fong GT. Patterns of cigarette, heated tobacco product, and nicotine vaping product use among Korean adults: Findings from the 2020 ITC Korea Survey. Tob Induc Dis 2024; 22:TID-22-63. [PMID: 38638419 PMCID: PMC11025448 DOI: 10.18332/tid/186273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Non-combustible nicotine products (NCNPs), such as heated tobacco products (HTPs) and nicotine vaping products (NVPs) have gained a significant nicotine market share in South Korea. This descriptive study examined patterns of regular cigarette and NCNP use among South Korean adults. METHODS Data were from the 2020 International Tobacco Control Korea Survey and included 4016 adults (aged ≥19 years) in the Republic of Korea who were regularly (at least weekly) using at least one NCNP (NVP/HTP, n=2117) and/or smoked cigarettes (n=3763) at the time of the survey. Weighted descriptive estimates were computed to assess respondents' nicotine product use among all respondents (exclusive, dual, or triple use). Thereafter, we identified sociodemographic characteristics associated with NCNP use (n=2117). RESULTS Among Korean adults who were smoking cigarettes, 83.1% (95% CI: 81.6-84.6) did so exclusively, and 16.9% (95% CI: 15.4-18.4) smoked cigarettes and used NCNPs. Among those who used HTPs (n=1877), 14.9% (95% CI: 11.5-18.4) did so exclusively, 59.6% used HTPs and smoked cigarettes (95% CI: 55.4-63.1), 4.2% used HTPs and vaped (95% CI: 11.5-18.4), and 21.6% (95% CI: 18.9-24.2) used all three products. Of adults who used HTPs and smoked cigarettes, 86.6% smoked daily. Among those who vaped (n=865), 13.3% did so exclusively (95% CI: 9.4-17.1), 55.6% (95% CI: 49.6-61.5) vaped and smoked cigarettes, 5.1% (95% CI: 1.7-8.6) used HTPs and vaped, and 26.1% (95% CI: 22.1-30.1) used all three products. Of adults who vaped and smoked cigarettes, 82.4% (95% CI: 77.1-87.7) smoked daily. CONCLUSIONS Cigarettes remain the most commonly used nicotine product in South Korea, and among adults using heated tobacco and/or vaping products, the majority were also smoking. Research is urgently needed to assess whether adults who are using an NCNP are doing so to quit, or rather to complement their cigarette smoking.
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Affiliation(s)
- Sungkyu Lee
- Korea Center for Tobacco Control Research and Education, Seoul, Republic of Korea
| | - Steve S. Xu
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Hong Gwan Seo
- Korea National Cancer Center, Goyang, Republic of Korea
| | - Sujin Lim
- National Tobacco Control Center, Korea Health Promotion Institute, Seoul, Republic of Korea
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Yeol Kim
- Korea National Cancer Center, Goyang, Republic of Korea
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
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Braznell S, Campbell J, Gilmore AB. What Can Current Biomarker Data Tell Us About the Risks of Lung Cancer Posed by Heated Tobacco Products? Nicotine Tob Res 2024; 26:270-280. [PMID: 37210693 PMCID: PMC10882439 DOI: 10.1093/ntr/ntad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/18/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Heated tobacco products (HTPs) are marketed as less harmful alternatives to cigarettes, but the lung cancer risk of HTPs is unknown. In the absence of epidemiological data, assessing the risks of HTPs relies on biomarker data from clinical trials. This study examined existing biomarker data to determine what it tells us about the lung cancer risk posed by HTPs. AIMS AND METHODS We identified all biomarkers of exposure and potential harm measured in HTP trials and evaluated their appropriateness based on ideal characteristics for measuring lung cancer risk and tobacco use. The effects of HTPs on the most appropriate biomarkers within cigarette smokers switched to HTPs and compared to continued cigarette smoking or cessation were synthesized. RESULTS Sixteen out of eighty-two biomarkers (7 exposure and 9 potential harm) measured in HTP trials have been associated with tobacco use and lung cancer, dose-dependently correlated with smoking, modifiable upon cessation, measured within an appropriate timeframe, and had results published. Three of the exposure biomarkers significantly improved in smokers who switched to HTPs and were not significantly different from cessation. The remaining 13 biomarkers did not improve-in some instances worsening upon switching to HTPs-or were inconsistently affected across studies. There were no appropriate data to estimate the lung cancer risk of HTPs in non-smokers. CONCLUSIONS The appropriateness of existing biomarker data in assessing lung cancer risk of HTPs, both relative to cigarettes and their absolute risk, is limited. Furthermore, findings on the most appropriate biomarkers were conflicting across studies and largely showed no improvement following a switch to HTPs. IMPLICATIONS Biomarker data are fundamental to assessing the reduced risk potential of HTPs. Our evaluation suggests much of the existing biomarker data on HTPs is inappropriate for determining the risk of lung cancer posed by HTPs. In particular, there is a paucity of data on the absolute lung cancer risk of HTPs, which could be obtained from comparisons to smokers who quit and never smokers exposed to or using HTPs. There is an urgent need for further exploration of the lung cancer risks posed by HTPs, via clinical trials and, in the long-term, confirmation of these risks via epidemiological studies. However, careful consideration should be given to biomarker selection and study design to ensure both are appropriate and will provide valuable data.
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Affiliation(s)
- Sophie Braznell
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | | | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
- SPECTRUM (Shaping Public Health Policies to Reduce Inequalities and Harm) Consortium, Bath, UK
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Liu Y, Filippidis FT. Tobacco market trends in 97 countries between 2007 and 2021. Tob Induc Dis 2024; 22:TID-22-31. [PMID: 38314375 PMCID: PMC10835573 DOI: 10.18332/tid/177441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 02/06/2024] Open
Abstract
INTRODUCTION Analysis of the tobacco market can provide valuable insights for developing tobacco control strategies. This study examines the market trends of cigarettes, cigars/cigarillos, smoking tobacco, smokeless tobacco, e-cigarettes, heated tobacco products (HTPs), and tobacco-free oral nicotine, across 97 countries between 2007 and 2021. METHODS We obtained annual tobacco retail value data from Euromonitor Passport and calculated the market share for each type of tobacco product. The research examined trends in retail value and market share globally, stratified by national income level, as well as in individual countries. RESULTS From 2007 to 2015, the growth of the global tobacco market was primarily driven by cigarette sales. However, starting in 2016, emerging products, including e-cigarettes, HTPs, and tobacco-free oral nicotine, as well as non-cigarette combustible products, including cigars/cigarillos and smoking tobacco, have been mostly responsible for the increases in the global tobacco retail value. High-income countries experienced the greatest increase in the retail value of emerging products, while middle- and low-income countries still observed rises in cigarette sales. CONCLUSIONS Trends in the retail value of different tobacco products varied widely during the study period, with distinct trends observed in different income levels and within individual countries. These trends can supplement prevalence data and be used to inform local tobacco control policies.
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Affiliation(s)
- Yifei Liu
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
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Chen DTH, Grigg J, Filippidis FT. European Respiratory Society statement on novel nicotine and tobacco products, their role in tobacco control and "harm reduction". Eur Respir J 2024; 63:2301808. [PMID: 38316440 DOI: 10.1183/13993003.01808-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Daniel Tzu-Hsuan Chen
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Jonathan Grigg
- Centre for Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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Kim SJ, Park BY. Changes in smoking patterns and characteristics of Koreans using the Korea National Health and Nutrition Examination Survey 2013-2021 data. Public Health 2024; 227:259-266. [PMID: 38301303 DOI: 10.1016/j.puhe.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVES This study explored factors related to Korean adults' smoking patterns and also the reasons for using new types of tobacco products. STUDY DESIGN Cross-sectional survey. METHODS Data from the Korea National Health and Nutrition Examination Survey from 2013 to 2021 were used. The prevalence of the use of electronic cigarettes (e-cigarettes) or heated tobacco products (HTPs) alone or in combination with conventional cigarettes (CC) and the reasons for using new tobacco products are presented. Factors associated with using new types of tobacco products alone or in combination with CC compared to exclusive CC users were identified using multinomial logistic regression analysis. RESULTS The prevalence of current smoking was 25.54% in 2013 and 23.05% in 2021, with no significant change. The prevalence of CC decreased from 23.39% in 2013 to 15.77% in 2021. The prevalence of new tobacco use in combination with CC did not show a definite trend. The prevalence of exclusive use of new tobacco was <1% until 2018 and has rapidly increased thereafter. Of the HTPs users, 46.68% responded with 'no cigarette smell' as the main reason for HTPs use, followed by 'It seems less harmful than cigarette' (19.19%), and 'It seems to be helpful for quitting smoking' (15.04%). Of the e-cigarette users, 45.19% responded 'It seems to be helpful for quitting smoking' as the main reason for e-cigarette use, followed by 'It is less harmful than cigarettes' (19.98%). Compared to CC users, new tobacco users were younger, had a higher household income or education, and used more nutritional supplements. CONCLUSION Regulations for newer tobacco products are more lenient than for traditional cigarettes, leading to misunderstandings, especially among women and young people. To increase awareness of the risks of these products, specific policies such as disclosure of ingredients, ban on online sales, and increase in consumption tax, are needed.
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Affiliation(s)
- S J Kim
- Department of Health Sciences, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea
| | - B Y Park
- Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Republic of Korea.
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Dorotheo EU, Arora M, Banerjee A, Bianco E, Cheah NP, Dalmau R, Eissenberg T, Hasegawa K, Naidoo P, Nazir NT, Newby LK, Obeidat N, Skipalskyi A, Stępińska J, Willett J, Wang Y. Nicotine and Cardiovascular Health: When Poison is Addictive - a WHF Policy Brief. Glob Heart 2024; 19:14. [PMID: 38312998 PMCID: PMC10836189 DOI: 10.5334/gh.1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/28/2023] [Indexed: 02/06/2024] Open
Abstract
Nicotine is universally recognized as the primary addictive substance fuelling the continued use of tobacco products, which are responsible for over 8 million deaths annually. In recent years, the popularity of newer recreational nicotine products has surged drastically in many countries, raising health and safety concerns. For decades, the tobacco industry has promoted the myth that nicotine is as harmless as caffeine. Nonetheless, evidence shows that nicotine is far from innocuous, even on its own. In fact, numerous studies have demonstrated that nicotine can harm multiple organs, including the respiratory and cardiovascular systems. Tobacco and recreational nicotine products are commercialized in various types and forms, delivering varying levels of nicotine along with other toxic compounds. These products deliver nicotine in profiles that can initiate and perpetuate addiction, especially in young populations. Notably, some electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) can deliver concentrations of nicotine that are comparable to those of traditional cigarettes. Despite being regularly advertised as such, ENDS and HTP have demonstrated limited effectiveness as tobacco cessation aids in real-world settings. Furthermore, ENDS have also been associated with an increased risk of cardiovascular disease. In contrast, nicotine replacement therapies (NRT) are proven to be safe and effective medications for tobacco cessation. NRTs are designed to release nicotine in a slow and controlled manner, thereby minimizing the potential for abuse. Moreover, the long-term safety of NRTs has been extensively studied and documented. The vast majority of tobacco and nicotine products available in the market currently contain nicotine derived from tobacco leaves. However, advancements in the chemical synthesis of nicotine have introduced an economically viable alternative source. The tobacco industry has been exploiting synthetic nicotine to circumvent existing tobacco control laws and regulations. The emergence of newer tobacco and recreational nicotine products, along with synthetic nicotine, pose a tangible threat to established tobacco control policies. Nicotine regulations need to be responsive to address these evolving challenges. As such, governments should regulate all tobacco and non-medical nicotine products through a global, comprehensive, and consistent approach in order to safeguard tobacco control progress in past decades.
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Affiliation(s)
| | | | - Amitava Banerjee
- University College London, United Kingdom
- Amrita Institute of Medical Sciences, India
| | | | | | | | | | - Koji Hasegawa
- National Hospital Organization Kyoto Medical Center, Japan
| | - Pamela Naidoo
- Heart and Stroke Foundation South Africa, South Africa
- University of the Western Cape, South Africa
| | | | | | | | | | - Janina Stępińska
- Department of Medical Communication, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
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Harada S, Ohmomo H, Matsumoto M, Sata M, Iida M, Hirata A, Miyagawa N, Kuwabara K, Kato S, Toki R, Edagawa S, Sugiyama D, Sato A, Hirayama A, Sugimoto M, Soga T, Tomita M, Shimizu A, Okamura T, Takebayashi T. Metabolomics profiles alterations in cigarette smokers and heated tobacco product users. J Epidemiol 2023:JE20230170. [PMID: 37926518 DOI: 10.2188/jea.je20230170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Heated tobacco products (HTPs) have gained global popularity, but their health risks remain unclear. Therefore, the current study aimed to identify plasma metabolites associated with smoking and HTP use in a large Japanese population to improve health risk assessment. METHODS Metabolomics data from 9,922 baseline participants of the Tsuruoka Metabolomics Cohort Study (TMCS) were analyzed to determine the association between smoking habits and plasma metabolites. Moreover, alterations in smoking-related metabolites among HTP users were examined based on data obtained from 3,334 participants involved from April 2018 to June 2019 in a follow-up survey. RESULTS Our study revealed that cigarette smokers had metabolomics profiles distinct from never smokers, with 22 polar metabolites identified as candidate biomarkers for smoking. These biomarker profiles of HTP users were closer to those of cigarette smokers than those of never smokers. The concentration of glutamate was higher in cigarette smokers, and biomarkers involved in glutamate metabolism were also associated with cigarette smoking and HTP use. Network pathway analysis showed that smoking was associated with the glutamate pathway, which could lead to endothelial dysfunction and atherosclerosis of the vessels. CONCLUSIONS Our study showed that the glutamate pathway is affected by habitual smoking. These changes in the glutamate pathway may partly explain the mechanism by which cigarette smoking causes cardiovascular disease. HTP use was also associated with glutamate metabolism, indicating that HTP use may contribute to the development of cardiovascular disease through mechanisms similar to those in cigarette use.
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Affiliation(s)
- Sei Harada
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
- Institute for Advanced Biosciences, Keio University
| | - Hideki Ohmomo
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University
| | - Minako Matsumoto
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Mizuki Sata
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Miho Iida
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Aya Hirata
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Naoko Miyagawa
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Kazuyo Kuwabara
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Suzuka Kato
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Ryota Toki
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Shun Edagawa
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Daisuke Sugiyama
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Asako Sato
- Institute for Advanced Biosciences, Keio University
| | | | | | | | | | - Atsushi Shimizu
- Iwate Tohoku Medical Megabank Organization, Iwate Medical University
| | - Tomonori Okamura
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
| | - Toru Takebayashi
- Department of Public Health and Preventive Medicine, Keio University School of Medicine
- Institute for Advanced Biosciences, Keio University
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Peña S, Ilmarinen K, Kestilä L, Ruokolainen O, Ollila H, Parikka S, Karvonen S. Changes in prevalence and sociodemographic correlates of tobacco and nicotine use in Finland during the COVID-19 pandemic. Eur J Public Health 2023; 33:844-850. [PMID: 37400989 PMCID: PMC10567130 DOI: 10.1093/eurpub/ckad104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The impact of the coronavirus disease 2019 (COVID-19) pandemic on tobacco and nicotine use remains debated. We examined whether the prevalence of tobacco and nicotine use and nicotine-replacement therapy (NRT) changed during the COVID-19 pandemic and whether changes differed by sociodemographic groups. METHODS Repeated cross-sectional study of three national surveys in Finland (2018, 2019 and 2020; n = 58 526 adults aged 20 and over). Outcomes were daily and occasional smoking, smokeless tobacco (snus) use, e-cigarettes use, total tobacco or nicotine use and NRT use. We examined changes for each outcome by sex, age, educational tertiles, marital status, mother tongue and social participation. RESULTS Daily smoking decreased among males by 1.15 percentage points (pp) [95% confidence interval (CI) -2.10 to -0.20] between 2018 and 2020 and 0.86 pp among females (95% CI -1.58 to -0.15). Daily snus use remained stable in both sexes. Daily e-cigarette use was below 1% and remained stable. We found weak evidence of a reduction in total tobacco or nicotine use between 2018 and 2020 (males -1.18 pp, 95% CI -2.68 to 0.32 and females -0.8 pp, 95% CI -1.81 to 0.22). NRT use remained stable. Snus and NRT use decreased among 60- to 74-year-olds but remained stable in other age groups. We did not find evidence of interactions by subgroup for other outcomes. CONCLUSIONS Daily smoking decreased in Finland between 2018 and 2020, but other forms of tobacco use did not experience a reduction. The COVID-19 pandemic does not seem to have altered the sustained reduction of smoking in Finland, although substantial sociodemographic differences persist.
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Affiliation(s)
- Sebastián Peña
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Katja Ilmarinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura Kestilä
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Suvi Parikka
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sakari Karvonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Kc S, Filippidis FT, Laverty AA. Legislative provisions for standardised tobacco packaging and changes in public support in 27 European countries. Tob Control 2023; 32:664-666. [PMID: 35017263 DOI: 10.1136/tobaccocontrol-2021-057068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/19/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Global adoption of standardised packaging requirements for tobacco products is a victory for public health, but their proliferation and impacts rely partly on public support. How this is related to legislation remains underassessed. This study explored change over time in public support for standardised packaging in countries with varying degrees of legislative provisions. METHODS We used data from 27 European countries, collected from 2017 (n=28, 300) and 2020 (n=27, 901) waves of the Eurobarometer survey, to assess self-reported support for standardised packaging regulations among both smokers and non-smokers. Countries were grouped into three categories of policy adoption (policy implemented; policy legislated; no legislation) and changes in support were assessed using multilevel Poisson regression models. RESULTS In 2020, public support for standardised packaging was 71% (95% CI 68% to 74%) in countries that implemented standardised packaging legislation, 57% (55% to 60%) in countries that had legislated but not yet implemented legislation and 41% (40%to 42%) in countries with no legislation. Compared with 2017, this represented a relative change of +8% (1% to 15%), +12% (5% to 21%) and -5% (95% CI -2% to -8%), respectively, in the three country categories. Among smokers, there was no indication of change in support across the three groups. Among non-smokers, support increased in countries with existing legislation (adjusted prevalence ratio [aPR]=1.14, 95% CI 1.06 to 1.23) and decreased in countries with no legislation (aPR=0.93, 0.90 to 0.97). CONCLUSIONS Public support for standardised packaging regulations increased in countries implementing and legislating for these measures, particularly among non-smokers. An overall increase in support provides reassurance for policymakers defending policy action on tobacco packaging, as well as for those seeking to implement standardised packaging in their own countries. .
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Affiliation(s)
- Sukriti Kc
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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15
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Upadhyay S, Rahman M, Johanson G, Palmberg L, Ganguly K. Heated Tobacco Products: Insights into Composition and Toxicity. TOXICS 2023; 11:667. [PMID: 37624172 PMCID: PMC10459283 DOI: 10.3390/toxics11080667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
Heated tobacco products (HTPs) are novel products that allow users to inhale nicotine by heating (350 °C) reconstituted tobacco rather than combustion (900 °C) as in conventional cigarettes. HTP sticks containing reconstituted tobacco come in various flavours such as menthol, citrus, etc., like electronic cigarette liquids. Thus, the composition of HTP aerosol will also vary according to the flavouring agents added. Overall, the content of toxic chemicals in HTP aerosol appears to be lower than in cigarette smoke. However, the concentrations of more than twenty harmful and potentially harmful constituents have been reported to be higher in HTP aerosol than in cigarette smoke. Further, several toxic compounds not detected in cigarette smoke are also reported in HTP aerosol. Thus, the risks of HTP use remain unknown. Most of the available data on the composition and health effects of mainstream HTP aerosol exposure are generated by the tobacco industry. Few independent studies have reported short-term pathophysiological effects of HTP use. Currently available HTP toxicity data are mainly on the pulmonary and cardiovascular systems. Moreover, there are no long-term toxicity data and, therefore, the claims of the tobacco industry regarding HTPs as a safer alternative to traditional combustible cigarettes are unsubstantiated. Furthermore, HTP aerosol contains the highly addictive substance nicotine, which is harmful to the adolescent brain, developing foetuses, pregnant women, and also adults. Hence, comprehensive studies addressing the safety profiling related to long-term HTP use are warranted. With this background, the following review summarizes the current state of knowledge on HTP toxicity on four broad lines: composition of mainstream HTP aerosol compared to traditional combustible cigarette smoke, biomarkers of HTP exposure, health effects of HTP exposure, and the harm reduction aspect.
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Affiliation(s)
- Swapna Upadhyay
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.R.); (G.J.); (L.P.)
| | | | | | | | - Koustav Ganguly
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.R.); (G.J.); (L.P.)
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16
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Alanazi AM, Monshi SS, Aldawsari NS, Almujel AA, Bin Saad WM, Alajlan SA, Alotaibi TF, Algarni SS, Abunurah HY, Alqahtani MM, Ismaeil TT, Al-Haddad MA, Hamilah SN, Abd Elmeguid WS, Al-Zalabani AH. The associations between cigarette smoking behavior and the use of heated tobacco products among Arab cigarette smokers: Findings from Saudi Arabia, Egypt, Kuwait, and Yemen. J Ethn Subst Abuse 2023:1-14. [PMID: 37184532 DOI: 10.1080/15332640.2023.2204075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
As the availability of tobacco forms has evolved, emerging products known as heated tobacco products (HTPs) are increasingly being consumed worldwide and are claimed to be less harmful than tobacco cigarette smoking. To date, it is unknown whether Arab cigarette smokers are using or susceptible to HTPs. Therefore, this study aimed to assess the association between cigarette smoking behavior and the use of and susceptibility to HTPs in the Eastern Mediterranean region. Arab cigarette smokers (n = 628) from Saudi Arabia, Egypt, Kuwait, and Yemen were recruited using a convenience sampling technique. A cross-sectional survey comprised questions related to sociodemographic characteristics, cigarette smoking behavior characteristics (quitting attempts and desire to quit cigarette smoking, nicotine dependence, and consideration of switching to nicotine products with reduced health risks), and awareness of, use of, and susceptibility to use of HTPs. Descriptive and logistic regression models were used for analysis. The participants indicated a high frequency of past quitting attempts and a desire to quit smoking cigarettes. They were also considering switching to a nicotine product with reduced health risks. However, their awareness of HTPs was relatively low (24.2%), and the proportion of participants who had ever used HTPs or were currently using them was quite low as well (10.7% and 5.0%, respectively). A history of quit attempts was associated with more likely lifetime use of HTPs (adjusted odds ratio [AOR] = 2.63, 95% confidence interval [CI] [1.21-5.71]). Nicotine-dependent cigarette smokers were more likely to be susceptible to HTP use (AOR = 1.12, 95% CI [1.01-1.24]). Moreover, those who would consider switching to a product that provided nicotine and could reduce health risks by 99% were more likely to be susceptible to using HTPs (AOR = 2.17, 95% CI [1.05-4.51]). Awareness of HTPs is relatively low among Arab cigarette smokers. Attempts to quit cigarette smoking, nicotine dependence, and the consideration of switching to a product that delivers nicotine with reduced health risks were significantly associated with using HTPs. The findings of this study provide potential for evidence-based treatment for smokers and will help prevent the use of tobacco industry tactics in marketing HTPs.
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Affiliation(s)
- Abdullah M Alanazi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Respiratory Services, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Sarah S Monshi
- Department of Health Services Management, College of public health and Health Informatics, Umm Al Qura University, Makkah, Saudi Arabia
| | - Noura S Aldawsari
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Alma A Almujel
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Waad M Bin Saad
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Shahad A Alajlan
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Tareq F Alotaibi
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Respiratory Services, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Saleh S Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Respiratory Services, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Hassan Y Abunurah
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Respiratory Services, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed M Alqahtani
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Taha T Ismaeil
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Respiratory Services, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Maath A Al-Haddad
- Physical Therapy Department, Allied Health Sciences, Kuwait University, Kuwait city, Kuwait
| | | | | | - Abdulmohsen H Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
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Won D, Jung W, Shin D. Comparison of the Smoking Cessation of Heated Tobacco Product Users and Conventional Cigarette Smokers in Korea. Korean J Fam Med 2023; 44:151-157. [PMID: 37225440 DOI: 10.4082/kjfm.22.0142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/08/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Since the introduction of heated tobacco products (HTPs) in Korea in 2017, their annual sales have increased. Several studies have investigated the perceptions of HTPs and smoking cessation behaviors. For the first time, In 2019, questions focused on HTP use were introduced in the Korea National Health and Nutrition Examination Survey (KNHNES). This study aimed to compare smoking cessation behaviors between HTP users and conventional cigarette smokers using KNHANES data. METHODS Data of 947 current adult smokers from the 8th KNHNES (2019) were analyzed. Current smokers were divided into conventional cigarette (CC)-only, HTP-only, and dual-use groups. The general characteristics of the three groups were investigated. Differences in current intention to quit smoking and past attempts to quit smoking among the three groups were analyzed using multivariate logistic regression analysis by IBM SPSS ver. 25.0. RESULTS HTP-only users demonstrated fewer future smoking cessation plans (adjusted odds ratio [AOR], 0.398; 95% confidence interval [CI], 0.195-0.813; P=0.012) and fewer smoking cessation attempts in the past year (AOR, 0.533; 95% CI, 0.298-0.954; P=0.034) than CC-only smokers. However, there was no significant difference between dual-use (CC+HTP) and CC-only smokers. CONCLUSION While dual-use and CC-only smokers showed similar smoking cessation behaviors, HTP-only users had fewer previous attempts to quit smoking and were less likely to be currently ready to quit smoking. These findings can be explained by a decrease in the need to quit smoking due to the convenience of HTP and the perception that HTPs are less harmful than CC.
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Affiliation(s)
- Doyeon Won
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wonyoung Jung
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongwook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
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18
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Seo HG, Xu SS, Li G, Gravely S, Quah ACK, Lee S, Lim S, Cho SI, Kim Y, Lee ES, Choi YJ, Miller CR, Goniewicz ML, O’Connor RJ, Fong GT. Reasons for Initiation and Regular Use of Heated Tobacco Products among Current and Former Smokers in South Korea: Findings from the 2020 ITC Korea Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4963. [PMID: 36981869 PMCID: PMC10048802 DOI: 10.3390/ijerph20064963] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
South Korea is the world's second-largest heated tobacco product (HTP) market after Japan. HTP sales in South Korea have increased rapidly since May 2017, accounting for 10.6% of the total tobacco market in 2020. Despite this, little is known as to why HTP consumers who were current and former smokers started using HTPs and used them regularly. We analyzed cross-sectional data for 1815 adults (aged 19+) who participated in the 2020 International Tobacco Control (ITC) Korea Survey, of whom 1650 were HTP-cigarette consumers (those who reported smoking cigarettes and using HTPs ≥ weekly) and 165 were exclusive HTP consumers (using HTPs ≥ weekly) who were former or occasional smokers (smoking cigarette < weekly). Respondents were asked to report the reason(s) they used HTPs, with 25 possible reasons for HTP-cigarette consumers and 22 for exclusive HTP consumers. The most common reasons for initiating HTP use among all HTP consumers were out of curiosity (58.9%), family and friends use HTPs (45.5%), and they like the HTP technology (35.9%). The most common reasons for regularly using HTPs among all HTP consumers were that they were less smelly than cigarettes (71.3%), HTPs are less harmful to own health than cigarettes (48.6%), and stress reduction (47.4%). Overall, 35.4% of HTP-cigarette consumers reported using HTPs to quit smoking, 14.7% to reduce smoking but not to quit, and 49.7% for other reasons besides quitting or reducing smoking. In conclusion, several common reasons for initiating and regularly using HTPs were endorsed by all HTP consumers who were smoking, had quit smoking completely, or occasionally smoked. Notably, only about one-third of HTP-cigarette consumers said they were using HTPs to quit smoking, suggesting that most had no intention of using HTPs as an aid to quit smoking in South Korea.
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Affiliation(s)
- Hong Gwan Seo
- Department of Family Medicine, National Cancer Center, Goyang 10408, Republic of Korea
- Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Republic of Korea
| | - Steve S. Xu
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Grace Li
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Sungkyu Lee
- Korea Center for Tobacco Control Research and Education, Seoul 04554, Republic of Korea
| | - Sujin Lim
- National Tobacco Control Center, Korea Health Promotion Institute, Seoul 04933, Republic of Korea
| | - Sung-il Cho
- Graduate School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
| | - Yeol Kim
- Department of Family Medicine, National Cancer Center, Goyang 10408, Republic of Korea
- Department of Cancer Control, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang 10408, Republic of Korea
| | - Eon Sook Lee
- Department of Family Medicine, Inje University, Ilsanpaik Hospital, Goyang 10380, Republic of Korea
| | - Yoon-Jung Choi
- Department of Family Medicine, National Cancer Center, Goyang 10408, Republic of Korea
| | - Connor R. Miller
- Division of Cancer Prevention and Population Sciences, Department of Health Behaviors, Roswell Park, Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Maciej L. Goniewicz
- Division of Cancer Prevention and Population Sciences, Department of Health Behaviors, Roswell Park, Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Richard J. O’Connor
- Division of Cancer Prevention and Population Sciences, Department of Health Behaviors, Roswell Park, Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
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Prevalence of Use and Knowledge about Tobacco Products and Their Harmful Effects among University Students in Southern Croatia. Healthcare (Basel) 2023; 11:healthcare11050771. [PMID: 36900776 PMCID: PMC10001000 DOI: 10.3390/healthcare11050771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Understanding students' attitudes toward smoking and tobacco products is essential for effective smoking prevention interventions. This questionnaire-based cross-sectional survey aims to determine the prevalence of use and knowledge about cigarettes, heated tobacco products, and electronic cigarettes and their harmful effects among university students. The survey was conducted using a self-administered online questionnaire among 1184 students. Questions were related to the respondents' demographic characteristics, tobacco use patterns, and opinions about exposure to health warnings and tobacco product advertising messages. Data were analyzed using descriptive statistics and generalized linear regression analysis. The results showed that 30.2% of the students use tobacco products (74.5% smoked conventional cigarettes; 7.9% used electronic cigarettes; and 17.6% used heated tobacco products). The median (interquartile range) score of the students' knowledge (maximum = 27) was 16 (12-22). The results showed that students from technical, social, humanities, natural, and biotechnology scientific programs had lower levels of knowledge about tobacco products and their harmful effects than biomedical students (p ≤ 0.001). In addition, past and current use of tobacco products was significantly associated with higher overall knowledge of tobacco products and their harmful effects (adjusted odds ratio (OR) 1.90, % confidence interval (CI) 1.09-3.31, p = 0.023; OR 1.41, CI 1.08-1.84, p = 0.011). The research findings confirm the lack of knowledge and misconceptions about the harmful effects associated with tobacco product use. They also emphasize the need for better prevention and awareness of the harmful effects of smoking on human health.
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Romanian young adult perceptions on using heated tobacco products following exposure to direct marketing methods. NPJ Prim Care Respir Med 2023; 33:8. [PMID: 36864067 PMCID: PMC9981255 DOI: 10.1038/s41533-023-00333-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023] Open
Abstract
Heated tobacco products have a rapid uptake, especially among young people, mostly where advertising is unregulated, as is the case in Romania. This qualitative study explores the influence of direct marketing methods of heated tobacco products on young people, their perception and behaviour towards smoking. We have carried out 19 interviews with smokers of heated tobacco products (HTPs) or/and combustible cigarettes (CCs) or non-smokers (NS), aged 18-26. Using the thematic analysis, we have identified three overarching themes: (1) people, places, and subjects of marketing, (2) engagement with risk narratives and (3) social body, family bonds, and autonomous self. Even if most of the participants have been exposed to a mix of marketing methods, they did not acknowledge the influence that marketing has on their decision to experience smoking. Young adults' decision to use heated tobacco products seems to be influenced by a cluster of reasons: overcoming the legislation gap which prohibits indoor use of combustible cigarettes but not heated tobacco products; the attractivity of the product (novelty, inviting appearance, technological appeal and price) and presumed less damaging effects on health.
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21
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Odani S, Tsuno K, Agaku IT, Tabuchi T. Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan. Tob Control 2023:tc-2022-057613. [PMID: 36849258 DOI: 10.1136/tc-2022-057613] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Heated tobacco products (HTPs) are often marketed as a safer alternative to help cigarette smokers quit. We investigated the link between HTP use and smoking cessation and relapse. METHODS 7044 adults (≥20 years old) with at least two observations over three waves (2019-2021) of a longitudinal, nationwide, internet-based survey were classified into current (past 30-day), former and never cigarette smokers. ≥1 month and ≥6 months smoking cessation and smoking relapse at 1-year follow-up were assessed in relation to current HTP use at baseline. Generalised estimating equation models were weighted to account for population differences between HTP users and non-users. Adjusted prevalence ratios (APRs) were computed within population subgroups. RESULTS At baseline, 17.2%, 9.1% and 6.1% of the respondents were current cigarette smokers, HTP users and dual users, respectively. Among current established smokers (having smoked regularly, n=1910), HTP use was significantly associated with a decreased likelihood of ≥1 month cessation within those who reported having used evidence-based cessation measures (APR=0.61), smoking 20+ cigarettes per day (APR=0.62), high school education or less (APR=0.73) and fair/poor health (APR=0.59). Negative associations were also seen for ≥6 months cessation among those aged 20-29 years (APR=0.56) and full-time workers (APR=0.56). Among former smokers (n=2906), HTP use was associated with smoking relapse within those who last smoked >1 year ago (APR=1.54), among women (APR=1.61), those aged 20-29 years (APR=2.09), those reporting high school education or less (APR=2.36), those who were unemployed/retired (AOR=3.31) and never/non-current alcohol users (APR=2.10). CONCLUSION HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.
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Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
| | - Israel T Agaku
- Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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22
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Sparrock LS, Phan L, Chen-Sankey J, Hacker K, Ajith A, Jewett B, Choi K. Heated Tobacco Products: Awareness, Beliefs, Use and Susceptibility among US Adult Current Tobacco Users, 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2016. [PMID: 36767383 PMCID: PMC9915028 DOI: 10.3390/ijerph20032016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 05/31/2023]
Abstract
Limited data exist on the awareness, beliefs, and use of heated tobacco products (HTPs). Data from 1583 U.S. adult (age ≥ 21 years) current tobacco users were collected in 2021. Participants self-reported HTP awareness, beliefs, use, and susceptibility, as well as current tobacco product use and sociodemographics. We used weighted logistic and multinomial regression models to explore their associations. Overall, 23.6% were aware of, 8.9% had ever used, and 3.0% currently used HTPs. Younger individuals (vs. 61+ years), those with annual income $50,000+ (vs. <$50,000), and those currently using electronic vaping products (vs. non-users) were more likely to be aware of, to have ever used, and to currently be using HTPs (p < 0.05). Black individuals (vs. White) were more likely to report ever and current HTP use (p < 0.05). Current cigarette smoking was not associated with HTP awareness and use (p > 0.05). Holding favorable HTP beliefs was associated with susceptibility to and more advanced HTP use statuses (p < 0.05). Sociodemographics associated with HTP use may reflect HTP marketing strategies. The lack of association with cigarette smoking suggests HTPs may be unlikely cigarette substitutes. Addressing favorable HTP-related beliefs may prevent dual use.
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Affiliation(s)
| | - Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854, USA
| | - Kiana Hacker
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Aniruddh Ajith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
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23
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Panagiotakos DB, Georgoulis M, Kapetanstrataki M, Behrakis P. Prevalence, patterns, and determinants of electronic cigarette and heated tobacco product use in Greece: A cross-sectional survey. Hellenic J Cardiol 2023; 70:10-18. [PMID: 36681120 DOI: 10.1016/j.hjc.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Electronic cigarettes (EC) and heated tobacco products (HTP) have been introduced in the global market as safer nicotine delivery systems; however, there is skepticism about their link to smoking and long-term risks. The aim of this study was to evaluate the prevalence, patterns, and determinants of EC/HTP use in Greece. METHODS This was a cross-sectional survey of 1,044 individuals aged ≥15 years old, who were randomly selected from the general Greek population. The study was conducted in May 2022, and participants were assessed through face-to-face interviews using a questionnaire designed to collect information on smoking and EC/HTP use, as well as their sociodemographic, lifestyle, and medical data. RESULTS The use of EC/HTP was reported by 16.2% of the participants, slightly more prevalent in males (17.2%) than in females (15.2%), and significantly more prevalent in <40-year-olds (21.3%) than ≥40-year-olds (11.3%). Most EC/HTP users (72.8%) were current smokers, 13.0% were former smokers, and 14.2% were never smokers. Among users, 60.6% used nicotine-containing products, 30.2% used EC/HTP in parallel with conventional tobacco, and 56.9% used EC/HTP for the first time while being <25 years old. In multiple logistic regression analysis, younger age, being employed, being a former/current smoker, adopting a Western-type diet, and believing that EC/HTP are less harmful than conventional tobacco products and can help toward smoking cessation emerged as significant determinants of EC/HTP use. CONCLUSIONS EC/HTP are commonly used in combination with conventional tobacco, are quite popular among the youth, and also appeal to a small fraction of nonsmokers.
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Affiliation(s)
- Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 176 76 Athens, Greece.
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 176 76 Athens, Greece
| | | | - Panagiotis Behrakis
- "George D. Behrakis" Research Lab, Hellenic Cancer Society, 105 57 Athens, Greece
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24
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Chapman F, Pour SJ, Wieczorek R, Trelles Sticken E, Budde J, Röwer K, Otte S, Mason E, Czekala L, Nahde T, O'Connell G, Simms L, Stevenson M. Twenty-eight day repeated exposure of human 3D bronchial epithelial model to heated tobacco aerosols indicates decreased toxicological responses compared to cigarette smoke. FRONTIERS IN TOXICOLOGY 2023; 5:1076752. [PMID: 36875887 PMCID: PMC9979258 DOI: 10.3389/ftox.2023.1076752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/09/2023] [Indexed: 02/18/2023] Open
Abstract
Tobacco harm reduction (THR) involves providing adult smokers with potentially reduced harm modes of nicotine delivery as alternatives to smoking combustible cigarettes. Heated tobacco products (HTPs) form a category with THR potential due to their ability to deliver nicotine and flavours through heating, not burning, tobacco. By eliminating burning, heated tobacco does not produce smoke but an aerosol which contains fewer and lower levels of harmful chemicals compared to cigarette smoke. In this study we assessed the in vitro toxicological profiles of two prototype HTPs' aerosols compared to the 1R6F reference cigarette using the 3D human (bronchial) MucilAir™ model. To increase consumer relevance, whole aerosol/smoke exposures were delivered repeatedly across a 28 day period (16, 32, or 48 puffs per exposure). Cytotoxicity (LDH secretion), histology (Alcian Blue/H&E; Muc5AC; FoxJ1 staining), cilia active area and beat frequency and inflammatory marker (IL-6; IL-8; MMP-1; MMP-3; MMP-9; TNFα) levels were assessed. Diluted 1R6F smoke consistently induced greater and earlier effects compared to the prototype HTP aerosols across the endpoints, and in a puff dependent manner. Although some significant changes across the endpoints were induced by exposure to the HTPs, these were substantially less pronounced and less frequently observed, with apparent adaptive responses occurring over the experimental period. Furthermore, these differences between the two product categories were observed at a greater dilution (and generally lower nicotine delivery range) for 1R6F (1R6F smoke diluted 1/14, HTP aerosols diluted 1/2, with air). Overall, the findings demonstrate the THR potential of the prototype HTPs through demonstrated substantial reductions in toxicological outcomes in in vitro 3D human lung models.
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Affiliation(s)
| | | | | | | | | | - Karin Röwer
- Reemtsma Cigarettenfabriken GmbH, Hamburg, Germany
| | - Sandra Otte
- Reemtsma Cigarettenfabriken GmbH, Hamburg, Germany
| | | | | | - Thomas Nahde
- Reemtsma Cigarettenfabriken GmbH, Hamburg, Germany
| | | | - Liam Simms
- Imperial Brands PLC, Bristol, United Kingdom
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25
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Morjaria JB, Campagna D, Caci G, O'Leary R, Polosa R. Health impact of e-cigarettes and heated tobacco products in chronic obstructive pulmonary disease: current and emerging evidence. Expert Rev Respir Med 2022; 16:1213-1226. [PMID: 36638185 DOI: 10.1080/17476348.2023.2167716] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Quitting is the only proven method to attenuate the progression of chronic obstructive pulmonary disease (COPD). However, most COPD smokers do not seem to respond to smoking cessation interventions and may benefit by lessening the negative health effects of long-term cigarette smoke exposure by switching to non-combustible nicotine delivery alternatives, such as heated tobacco products (HTPs) and e-cigarettes (ECs). AREAS COVERED Compared with conventional cigarettes, HTPs and ECs offer substantial reduction in exposure to toxic chemicals and have the potential to reduce harm from cigarette smoke when used as tobacco cigarette substitutes. In this review, we examine the available clinical studies and population surveys on the respiratory health effects of ECs and HTPs in COPD patients. EXPERT OPINION The current research on the impact of ECs and HTPs on COPD patients' health is limited, and more high-quality studies are needed to draw definitive conclusions. However, this review provides a comprehensive overview of the available literature for health professionals looking to advise COPD patients on the use of these products. While ECs and HTPs may offer some benefits in reducing harm from cigarette smoke, their long-term effects on COPD patients' health are still unclear.
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Affiliation(s)
- Jaymin B Morjaria
- Department of Respiratory Medicine, Guy's & St Thomas' NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Davide Campagna
- U.O.C. MCAU, University Teaching Hospital 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Grazia Caci
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), Università di Catania, Catania, Italy
| | - Renee O'Leary
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
| | - Riccardo Polosa
- U.O.C. MCAU, University Teaching Hospital 'Policlinico-Vittorio Emanuele', University of Catania, Catania, Italy
- Centre for the Prevention and Treatment of Tobacco Addiction (CPCT), Teaching Hospital "Policlinico - V. Emanuele", University of Catania, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- ECLAT Srl, Spin-off of the University of Catania, Catania, Italy
- Institute of Internal Medicine, AOU "Policlinico - V. Emanuele - S. Marco", Catania, Italy
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26
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Wu YS, Chan HL, Ho SY, Zhao SZ, Luk TT, Lam TH, Wang MP. A content analysis of heated tobacco product business in Hong Kong on Facebook. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5685-e5692. [PMID: 36062525 DOI: 10.1111/hsc.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Heated tobacco products (HTPs) are increasingly popular in Hong Kong (HK) even though they have not been formally launched and the sale of duty-not-paid tobacco sticks is illegal. We investigated how Facebook was used against regulations to sell HTPs in HK. We screened Facebook pages run by HTP businesses targeting HK users in June 2019 and included pages with over 300 "Likes" for inductive content analysis by coding their "About" descriptions and all posts including comments published since January 2017. HTPs included heating devices, accessories, and tobacco sticks. Various attributes were recorded including methods of customer inquiries (telephone, Instant Messaging [IM], address), business responses (comments or private messages, PM), and services provided (warranty/repair). Among 30 pages (50.9% of all 59 eligible pages with related information on HTPs), two-thirds provided phone numbers (66.7%), IM accounts (65.5%), and addresses (66.7%). Most pages sold heating devices (26, 86.7%) and accessories (22, 73.3%) with over 72% providing phone numbers, IM accounts, or addresses. Only 8 pages (26.7%) sold tobacco sticks with 75.0% providing telephone numbers but fewer provided IM accounts (62.5%) and addresses (50.0%). All pages responded using PMs and only 12.5% also used comments. Warranty/repair services were provided by 43.3% of the pages. We found Facebook pages were used as dedicated stores to promote and sell HTPs including heating devices, accessories, and even illicit tobacco sticks in HK, a non-official market.
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Affiliation(s)
| | - Hiu Laam Chan
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Sheng Zhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
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27
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Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
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28
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Rahman M, Irmler M, Introna M, Beckers J, Palmberg L, Johanson G, Upadhyay S, Ganguly K. Insight into the pulmonary molecular toxicity of heated tobacco products using human bronchial and alveolar mucosa models at air-liquid interface. Sci Rep 2022; 12:16396. [PMID: 36180488 PMCID: PMC9525689 DOI: 10.1038/s41598-022-20657-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/16/2022] [Indexed: 11/09/2022] Open
Abstract
Heated tobacco products (HTP) are novel nicotine delivery products with limited toxicological data. HTP uses heating instead of combustion to generate aerosol (HTP-smoke). Physiologically relevant human bronchial and alveolar lung mucosa models developed at air-liquid interface were exposed to HTP-smoke to assess broad toxicological response (n = 6-7; ISO puffing regimen; compared to sham; non-parametric statistical analysis; significance: p < 0.05). Elevated levels of total cellular reactive oxygen species, stress responsive nuclear factor kappa-B, and DNA damage markers [8-hydroxy-2'-deoxyguanosine, phosphorylated histone H2AX, cleaved poly-(ADP-Ribose) polymerase] were detected in HTP-smoke exposed bronchial and/or alveolar models. RNA sequencing detected differential regulation of 724 genes in the bronchial- and 121 genes in the alveolar model following HTP-smoke exposure (cut off: p ≤ 0.01; fold change: ≥ 2). Common enriched pathways included estrogen biosynthesis, ferroptosis, superoxide radical degradation, xenobiotics, and α-tocopherol degradation. Secreted levels of interleukin (IL)1ꞵ and IL8 increased in the bronchial model whereas in the alveolar model, interferon-γ and IL4 increased and IL13 decreased following HTP-smoke exposure. Increased lipid peroxidation was detected in HTP-smoke exposed bronchial and alveolar models which was inhibited by ferrostatin-1. The findings form a basis to perform independent risk assessment studies on different flavours of HTP using different puffing topography and corresponding chemical characterization.
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Affiliation(s)
- Mizanur Rahman
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Martin Irmler
- Institute of Experimental Genetics, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), 85764, Neuherberg, Germany
| | - Micol Introna
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Johannes Beckers
- Institute of Experimental Genetics, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD E.V.), 85764, Neuherberg, Germany.,Chair of Experimental Genetics, Technical University of Munich, 85354, Freising, Germany
| | - Lena Palmberg
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Gunnar Johanson
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Swapna Upadhyay
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Koustav Ganguly
- Unit of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, 171 77, Stockholm, Sweden.
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29
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Teshima A, Laverty AA, Filippidis FT. Burden of current and past smoking across 28 European
countries in 2017: A cross-sectional analysis. Tob Induc Dis 2022; 20:56. [PMID: 35799620 PMCID: PMC9194927 DOI: 10.18332/tid/149477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Most studies use the prevalence of current smoking as an indicator to quantify the burden of smoking. However, length and intensity of smoking, as well as time since cessation for former smokers are also known to impact smoking-related health risks. The aim of this study was to quantify and compare the burden of smoking across the European Union (EU) using a range of smoking burden indicators. METHODS We conducted a cross-sectional analysis using data from the March 2017 Eurobarometer 87.1 (n=27901, people aged ≥15 years) in 28 European Union Member States (EU MS) and the Tobacco Control Scale. We defined five indicators of smoking burden including the prevalence of current and ever smoking, length of smoking, pack-years, and discounted pack-years, and ranked EU MS by each indicator. Two-level linear and logistic regressions were performed to assess the association between these indicators and sociodemographic and tobacco policy factors. RESULTS Wide variations across the EU countries were observed in all smoking burden indicators. While some MS ranked consistently high (e.g. Greece, France) or consistently low (e.g. Ireland, United Kingdom) in all indicators, we found substantial discrepancies in ranking depending on the indicator used for MS such as Malta, Denmark, Finland and the Netherlands. All indicators of smoking burden were lower among women and respondents without financial difficulties; however, the magnitude of those inequalities varied two-fold among the different indicators. CONCLUSIONS Using a range of smoking burden indicators can be more informative than relying on prevalence alone. Our analysis highlights the limitations of relying solely on prevalence of current smoking to estimate the burden of smoking and the potential value of more nuanced indicators. We recommend that multiple and more nuanced indicators that consider former smokers, intensity and duration of smoking should be utilized to monitor tobacco use and evaluate tobacco control policies.
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Affiliation(s)
- Ayaka Teshima
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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30
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Havermans A, van Nierop LE, Pauwels CGGM, Talhout R. “It’s Like Jogging Next to the Highway”: A Qualitative Analysis of the Motivations and Experiences of Single-, Dual-, and Ex-Users of IQOS in The Netherlands. TOXICS 2022; 10:toxics10060283. [PMID: 35736892 PMCID: PMC9229017 DOI: 10.3390/toxics10060283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023]
Abstract
The popularity of heated tobacco products (HTPs) is of concern, as most users are dual users exposed to emissions of both HTPs and conventional cigarettes. Furthermore, HTPs may appeal to young people and non-smokers. This study aims to build intelligence on user experiences in order to inform policy development. We conducted five semi-structured focus group interviews with single-, dual-, and ex-users of the HTP IQOS. The discussions focused on initiation and use, experiences and perception, and knowledge and information needs. We performed a thematic analysis of the transcripts. All users smoked cigarettes and/or roll your own (RYO) tobacco before using HTP. We found that almost all users started using IQOS after being introduced to it by others. Single users successfully quit smoking cigarettes using the IQOS, liked the taste, and experienced physical benefits. Dual users experienced more satisfaction from smoking cigarettes and used the IQOS for specific occasions, such as social situations or in places with smoking bans. All IQOS users described themselves as smokers and considered using the IQOS as an alternative way of smoking. Regulators may consider providing reliable and easily accessible information and regulating points of sale, promotional activities, and product properties such as flavors and devices in order to reduce product attractiveness and discourage use.
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31
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Pénzes M, Joó T, Urbán R. Perceived harm of heated tobacco products, e-cigarettes, and nicotine replacement therapy compared with conventional cigarettes among ever and current heated tobacco users. Addict Behav Rep 2022; 15:100432. [PMID: 35600227 PMCID: PMC9121183 DOI: 10.1016/j.abrep.2022.100432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 11/26/2022] Open
Abstract
Hungarian HTP users similarly perceive the harm of HTPs and NRT. Compared to CCs, HTP users perceive HTPs less harmful than of e-cigarettes. Current and exclusive HTP users more likely perceive HTPs as less harmful than CCs. HTP users have distorted harm perceptions of nicotine products.
Aims There is limited knowledge on how ever and current heated tobacco product (HTP) users perceive the relative harm of various nicotine-containing products. The aim of this study was to explore relative harm perceptions of HTPs, e-cigarettes, and nicotine replacement therapy (NRT) relative to conventional cigarettes (CCs) among ever versus current HTP users, and exclusive (who use only a HTP) versus dual/poly-users (concurrent users of HTP and CCs and/or e-cigarettes). Methods Data came from 1423 ever or current Hungarian adult HTP users who participated in a cross-sectional web-based survey in 2020. Unadjusted and adjusted logistic regression analyses were performed to explore the associations between relative harm perceptions, HTP use patterns, past tobacco use, HTP dependence, and socio-demographic variables. Results 81.2% of the sample was current HTP users, of them 78.4% were exclusive HTP users. Compared to CCs, 86.2% of the sample perceived HTP to be less harmful, with current and exclusive HTP users endorsing more this belief, followed by NRT (79.8%), and e-cigarettes (45.2%). In general, neither socio-demographic variables nor past tobacco use, HTP use pattern, and HTP dependence were related to perceived harmfulness across the tested products. However, there was a specific pattern for each tested product with a set of explanatory variables. Conclusions Ever/current HTP users presented misperceptions about the harms of HTPs, e-cigarettes, and NRT. They underestimated the potential health benefits of NRT and had distorted harm perceptions about HTPs and e-cigarettes. Public education about the relative harms of different nicotine and tobacco products is urgently needed.
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El Asmar ML, Laverty AA, Vardavas CI, Filippidis FT. How do Europeans quit using tobacco, e-cigarettes and heated tobacco products? A cross-sectional analysis in 28 European countries. BMJ Open 2022; 12:e059068. [PMID: 35487758 PMCID: PMC9058771 DOI: 10.1136/bmjopen-2021-059068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES While smoking tobacco remains a substantial cause of harm in Europe, novel products such as electronic cigarettes or e-cigarettes (ECs) and heated tobacco products (HTPs) have entered the market recently. While debate still persists over the role of these novel products, they are now in widespread use. This study aimed to explore the prevalence and methods of attempts to quit EC and HTP. SETTING We analysed the 2020 Eurobarometer survey, which collected data in 28 European countries. PARTICIPANTS A representative sample of individuals residing in these countries aged ≥15 years. PRIMARY AND SECONDARY OUTCOME MEASURES Multilevel regression analyses were performed to assess differences in quit attempts and cessation methods among tobacco smokers and exclusive EC/HTP users separately. RESULTS 51.1% of current tobacco smokers and 27.1% of exclusive EC or HTP users reported having ever made a quit attempt. The majority of former and current smokers (75.8%) who made a quit attempt did so unassisted, with 28.8% reporting at least one attempt using a cessation aid. The most popular cessation aids were nicotine replacement therapy or other medication (13.4%) and ECs (11.3%). 58.8% of exclusive EC or HTP users who had made a quit attempt did so unassisted, with 39.5% reporting the use of a cessation aid. CONCLUSION Most EC and HTP users in Europe try to quit unassisted, although more of them report the use of a cessation aid compared with tobacco smokers. Cessation support services should take into consideration the increasing numbers of users of EC and HTP who may be trying to quit.
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Affiliation(s)
- Marie Line El Asmar
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Filippos T Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
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Vardavas CI. European Tobacco Products Directive (TPD): current impact and future steps. Tob Control 2022; 31:198-201. [PMID: 35241588 DOI: 10.1136/tobaccocontrol-2021-056548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
Efforts to reduce the toll of tobacco-related morbidity and mortality in the European Union are spearheaded by the Tobacco Products Directive (TPD), a legal act implemented during 2016-2021, with the overall aim to reduce tobacco consumption by 2% in Europe. Within this time frame, several core tobacco control measures were implemented, the impact of which is outlined within this manuscript. Key successful legislative actions implemented in this time frame led to greater availability of information and further regulation of additives, the banning of mentholated cigarettes, enhanced pictorial package warnings and a regulatory framework for e-cigarettes. While repeated cross-sectional data indicated a 12.5% relative reduction in smoking prevalence after implementation of the TPD, the differential regulation of cigarettes and roll-your-own tobacco compared with other products, such as cigarillos, e-cigarettes and heated tobacco products, may have also led to product displacement. Moreover, as the TPD could not keep up with the ever-changing nicotine product landscape, further adaptations may be needed.
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Tattan-Birch H, Hartmann-Boyce J, Kock L, Simonavicius E, Brose L, Jackson S, Shahab L, Brown J. Heated tobacco products for smoking cessation and reducing smoking prevalence. Cochrane Database Syst Rev 2022; 1:CD013790. [PMID: 34988969 PMCID: PMC8733777 DOI: 10.1002/14651858.cd013790.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Heated tobacco products (HTPs) are designed to heat tobacco to a high enough temperature to release aerosol, without burning it or producing smoke. They differ from e-cigarettes because they heat tobacco leaf/sheet rather than a liquid. Companies who make HTPs claim they produce fewer harmful chemicals than conventional cigarettes. Some people report stopping smoking cigarettes entirely by switching to using HTPs, so clinicians need to know whether they are effective for this purpose and relatively safe. Also, to regulate HTPs appropriately, policymakers should understand their impact on health and on cigarette smoking prevalence. OBJECTIVES To evaluate the effectiveness and safety of HTPs for smoking cessation and the impact of HTPs on smoking prevalence. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group's Specialised Register, CENTRAL, MEDLINE, and six other databases for relevant records to January 2021, together with reference-checking and contact with study authors and relevant groups. SELECTION CRITERIA We included randomised controlled trials (RCTs) in which people who smoked cigarettes were randomised to switch to exclusive HTP use or a control condition. Eligible outcomes were smoking cessation, adverse events, and selected biomarkers. RCTs conducted in clinic or in an ambulatory setting were deemed eligible when assessing safety, including those randomising participants to exclusively use HTPs, smoke cigarettes, or attempt abstinence from all tobacco. Time-series studies were also eligible for inclusion if they examined the population-level impact of heated tobacco on smoking prevalence or cigarette sales as an indirect measure. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking at the longest follow-up point available, adverse events, serious adverse events, and changes in smoking prevalence or cigarette sales. Other outcomes included biomarkers of harm and exposure to toxicants/carcinogens (e.g. NNAL and carboxyhaemoglobin (COHb)). We used a random-effects Mantel-Haenszel model to calculate risk ratios (RR) with 95% confidence intervals (CIs) for dichotomous outcomes. For continuous outcomes, we calculated mean differences on the log-transformed scale (LMD) with 95% CIs. We pooled data across studies using meta-analysis where possible. MAIN RESULTS We included 13 completed studies, of which 11 were RCTs assessing safety (2666 participants) and two were time-series studies. We judged eight RCTs to be at unclear risk of bias and three at high risk. All RCTs were funded by tobacco companies. Median length of follow-up was 13 weeks. No studies reported smoking cessation outcomes. There was insufficient evidence for a difference in risk of adverse events between smokers randomised to switch to heated tobacco or continue smoking cigarettes, limited by imprecision and risk of bias (RR 1.03, 95% CI 0.92 to 1.15; I2 = 0%; 6 studies, 1713 participants). There was insufficient evidence to determine whether risk of serious adverse events differed between groups due to very serious imprecision and risk of bias (RR 0.79, 95% CI 0.33 to 1.94; I2 = 0%; 4 studies, 1472 participants). There was moderate-certainty evidence for lower NNAL and COHb at follow-up in heated tobacco than cigarette smoking groups, limited by risk of bias (NNAL: LMD -0.81, 95% CI -1.07 to -0.55; I2 = 92%; 10 studies, 1959 participants; COHb: LMD -0.74, 95% CI -0.92 to -0.52; I2 = 96%; 9 studies, 1807 participants). Evidence for additional biomarkers of exposure are reported in the main body of the review. There was insufficient evidence for a difference in risk of adverse events in smokers randomised to switch to heated tobacco or attempt abstinence from all tobacco, limited by risk of bias and imprecision (RR 1.12, 95% CI 0.86 to 1.46; I2 = 0%; 2 studies, 237 participants). Five studies reported that no serious adverse events occurred in either group (533 participants). There was moderate-certainty evidence, limited by risk of bias, that urine concentrations of NNAL at follow-up were higher in the heated tobacco use compared with abstinence group (LMD 0.50, 95% CI 0.34 to 0.66; I2 = 0%; 5 studies, 382 participants). In addition, there was very low-certainty evidence, limited by risk of bias, inconsistency, and imprecision, for higher COHb in the heated tobacco use compared with abstinence group for intention-to-treat analyses (LMD 0.69, 95% CI 0.07 to 1.31; 3 studies, 212 participants), but lower COHb in per-protocol analyses (LMD -0.32, 95% CI -1.04 to 0.39; 2 studies, 170 participants). Evidence concerning additional biomarkers is reported in the main body of the review. Data from two time-series studies showed that the rate of decline in cigarette sales accelerated following the introduction of heated tobacco to market in Japan. This evidence was of very low-certainty as there was risk of bias, including possible confounding, and cigarette sales are an indirect measure of smoking prevalence. AUTHORS' CONCLUSIONS No studies reported on cigarette smoking cessation, so the effectiveness of heated tobacco for this purpose remains uncertain. There was insufficient evidence for differences in risk of adverse or serious adverse events between people randomised to switch to heated tobacco, smoke cigarettes, or attempt tobacco abstinence in the short-term. There was moderate-certainty evidence that heated tobacco users have lower exposure to toxicants/carcinogens than cigarette smokers and very low- to moderate-certainty evidence of higher exposure than those attempting abstinence from all tobacco. Independently funded research on the effectiveness and safety of HTPs is needed. The rate of decline in cigarette sales accelerated after the introduction of heated tobacco to market in Japan but, as data were observational, it is possible other factors caused these changes. Moreover, falls in cigarette sales may not translate to declining smoking prevalence, and changes in Japan may not generalise elsewhere. To clarify the impact of rising heated tobacco use on smoking prevalence, there is a need for time-series studies that examine this association.
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Affiliation(s)
- Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Loren Kock
- Department of Behavioural Science and Health, University College London, London, UK
| | - Erikas Simonavicius
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Leonie Brose
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
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