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Fearon IM, Cordery SF, Fitzpatrick M, Weaver S, Stevenson M, Grandolfo E, Malt L, Thompson K, Nahde T. A Scoping Review of Behavioural Studies on Heated Tobacco Products. Cureus 2024; 16:e65773. [PMID: 39211653 PMCID: PMC11361622 DOI: 10.7759/cureus.65773] [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] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Heated tobacco products (HTPs) are electronic devices that heat tobacco sticks to temperatures much lower than those which cause pyrolysis and combustion in cigarettes. While this electrical heating causes the formation of an inhalable aerosol which contains nicotine, the aerosol from HTPs contains significantly fewer and lower levels of the harmful and potentially harmful chemicals found in cigarette smoke. As a result, HTP use potentially conveys reduced risks to health compared to cigarette smoking. While this relative reduction in individual health risk is becoming clearer, what is less certain is the impact of HTPs on overall population‑level health, taking into account both the potential positive impact on adult smokers who completely switch to using HTPs and any unintended impacts such as use by tobacco non‑users and particularly by youth. The aim of this scoping review was to collate and evaluate the published scientific evidence to date, with a cut‑off of 1 January 2024, investigating the impact of HTPs on population‑level health. This evaluation suggests that HTP use is almost exclusively observed among those with a history of cigarette smoking, and there is a growing body of evidence for the ability of HTPs to provide support for adult smokers to transition away from cigarette smoking, in the absence of any significant "gateway" into tobacco use initiation. Many studies have reported a significant degree of dual use of cigarettes and HTPs, and efforts to assess the reasons for such patterns of use, whether these provide overall exposure reductions, and whether dual use acts as a bridge towards a complete transition away from cigarette smoking, requires further investigation. In addition, correction of the widespread and increasing misperceptions of HTPs among adult smokers is recommended to promote HTP uptake as a potentially less harmful alternative to smoking in this population.
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Affiliation(s)
- Ian M Fearon
- Scientific Research, whatIF? Consulting Ltd., Harwell, GBR
| | - Sarah F Cordery
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | | | - Sarah Weaver
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Matthew Stevenson
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Erika Grandolfo
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Layla Malt
- Group Science and Regulatory Affairs, Imperial Brands PLC, Bristol, GBR
| | - Keith Thompson
- Scientific Consultant, Elucid8 Holdings Ltd., Newtownabbey, GBR
| | - Thomas Nahde
- Group Science and Regulatory Affairs, Imperial Brands Reemtsma, Hamburg, DEU
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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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Braznell S, Branston JR, Gilmore AB. Corporate communication of the relative health risks of IQOS through a webchat service. Tob Control 2023; 32:e205-e211. [PMID: 35241501 PMCID: PMC10423550 DOI: 10.1136/tobaccocontrol-2021-056999] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/31/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Communication of the relative health risks of IQOS can attract potential consumers, aiding its commercial success. However, health-related claims need to be used cautiously to avoid inaccuracies and attracting non-smokers. We used the live webchat service on the IQOS website to identify information and claims on the relative risks of IQOS made directly to potential consumers in different countries. METHODS The study was promoted through authors' networks and conducted between 1 August and 30 November 2020. Participants collected webchat conversation responses to three queries regarding the safety of IQOS relative to cigarettes and e-cigarettes using step-by-step guidance and a predesigned form. Responses were analysed to identify health-related claims and information provided. RESULTS 70 webchat attempts were recorded across 27 countries, 54 of which (in 22 countries) were successful webchat conversations. In 48 of these, one or more claims were used to indicate IQOS is safer than cigarettes, such as IQOS is smoke free, emits less harmful substances or reduces harm. Four conversations contained statements indicating IQOS is safer than e-cigarettes. Some statements provided were contradictory. Participant age was consistently requested on accessing the website, but tobacco/nicotine use was not. Other information provided included referral to the 2020 US Food and Drug Administration Modified Risk Tobacco Product decision, IQOS or Philip Morris International web pages and claims that IQOS is not risk free nor a cessation device. CONCLUSIONS A variety of claims and information on the relative safety of IQOS were used in webchat communications. Response variation highlights that clearer regulation is needed to appropriately control corporate communications via live webchat services.
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Crosbie E, Severini G, Beem A, Tran B, Sebrie EM. New tobacco and nicotine products in Latin America and the Caribbean: assessing the market and regulatory environment. Tob Control 2023; 32:458-466. [PMID: 34916305 DOI: 10.1136/tobaccocontrol-2021-056959] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To document the regulatory environment of new tobacco and nicotine products (NTNPs), including electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs), in Latin America and the Caribbean (LAC). METHODS Review of market research reports and databases, regulatory websites, Campaign for Tobacco-Free Kids, relevant published literature and the 2021 WHO Report on the Global Tobacco Epidemic. RESULTS ENDS entered the LAC market in the 2010s and are now available in most LAC countries. A majority of LAC countries (n=18) have either banned the commercialisation of ENDS (n=7) or regulated ENDS as tobacco products (n=7), medicinal products (n=1) or consumer products (n=3). The remaining LAC countries (n=15) do not regulate ENDS. HTPs were first introduced in 2017 and have been officially launched in five countries (Colombia, Guatemala, Dominican Republic, Mexico and Costa Rica). Few countries have banned HTP commercialisation (n=3) or regulated commercialisation and use (n=7), while the majority of countries have existing legislation that applies to HTPs (n=19). A few countries (n=4) have no tobacco control legislation and therefore do not regulate HTPs. CONCLUSION NTNPs are emerging products in the LAC region. Governments should follow WHO guidance and the decisions of the Conference of Parties to the WHO Framework Convention on Tobacco Control and ban or regulate NTNPs as tobacco products; otherwise NTNPs could create a new generation of tobacco and nicotine users.
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Affiliation(s)
- Eric Crosbie
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | | | | | - Brian Tran
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
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O'Connor R, Schneller LM, Felicione NJ, Talhout R, Goniewicz ML, Ashley DL. Evolution of tobacco products: recent history and future directions. Tob Control 2022; 31:175-182. [PMID: 35241585 DOI: 10.1136/tobaccocontrol-2021-056544] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022]
Abstract
Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery. These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade.
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Affiliation(s)
- Richard O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA richard.o'
| | - Liane M Schneller
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Nicholas J Felicione
- Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Reinskje Talhout
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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Loud EE, Gallegos-Carrillo K, Barrientos-Gutiérrez I, Arillo-Santillán E, Lambert VC, Zavala-Arciniega L, Thrasher JF. Smoking Behaviors, Mental Health, and Risk Perceptions during the Beginning of the COVID-19 Pandemic among Mexican Adult Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10905. [PMID: 34682643 PMCID: PMC8535597 DOI: 10.3390/ijerph182010905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/24/2021] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
Mexico is one of the countries most affected by COVID-19. Studies have found that smoking behaviors have been impacted by the pandemic as well; however, results have varied across studies, and it remains unclear what is causing the changes. This study of an open cohort of smokers recruited from a consumer panel (n = 2753) examined changes in cigarettes per day (CPD), daily vs. non-daily smoking, recent quit attempts, perceived stress, depression, and perceived severity of COVID-19 at two points during the pandemic: March and July 2020. Differences in CPD between waves were estimated with Poisson regression using generalized estimating equations (GEE). Differences in perceived stress were estimated with linear regression using GEE, and differences in recent quit attempts, depression, and perceived severity of COVID-19 were estimated using separate logistic regression GEE models. Rates of depression were higher in July compared to March (AOR = 1.55, 95% C.I. 1.31-1.85), and the likelihood of recent quit attempt was lower in July compared to March (AOR = 0.85, 95% C.I. 0.75-0.98). There was no statistically significant change in CPD, daily smoking, or perceived stress. Perceived COVID-19 severity for oneself increased significantly (AOR: 1.24, 95% C.I. 1.02-1.52); however, the perceived COVID-19 severity for smokers remained constant. Our study suggests that as the COVID-19 pandemic expanded in Mexico, smoking frequency remained stable, and quit attempts decreased, even as adult smokers increasingly perceived infection with COVID-19 for themselves as severe. These results can aid in the development of health communication strategies to educate smokers about their risk for COVID-19, potentially capitalizing on concerns that stem from this syndemic of communicable and smoking-related non-communicable disease.
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Affiliation(s)
- Emily E. Loud
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA; (V.C.L.); (J.F.T.)
| | - Katia Gallegos-Carrillo
- Epidemiological and Health Services Research Unit, Mexican Social Security Institute, Cuernavaca 62000, Mexico;
| | | | - Edna Arillo-Santillán
- National Institute of Public Health, Mexico City 62100, Mexico; (I.B.-G.); (E.A.-S.)
| | - Victoria C. Lambert
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA; (V.C.L.); (J.F.T.)
| | | | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA; (V.C.L.); (J.F.T.)
- National Institute of Public Health, Mexico City 62100, Mexico; (I.B.-G.); (E.A.-S.)
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Heated Tobacco Products: Awareness and Ever Use Among U.S. Adults. Am J Prev Med 2021; 60:684-691. [PMID: 33518430 DOI: 10.1016/j.amepre.2020.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Heated tobacco products, also referred to as heat-not-burn tobacco, are among the latest products introduced to the market by the tobacco industry. However, data on heated tobacco product awareness and use from population-based probability surveys are limited. This study examines heated tobacco product awareness and ever use among U.S. adults. METHODS This study used data (n=42,477) from the 2019 Tobacco Use Supplement to the Current Population Survey, analyzed in 2020. Descriptive statistics, including a weighted prevalence of heated tobacco product awareness and ever use, were estimated. The awareness and ever use of heated tobacco products were also estimated by age, sex, cigarette smoking status, E-cigarette use status, and other tobacco product use status. Multivariable logistic regression examined the individual characteristics associated with the awareness and ever use of heated tobacco products. RESULTS Overall, approximately 8.6% of U.S. adults were aware of heated tobacco products. Awareness was higher among participants who were younger, male, cigarette smokers, E-cigarette users, and other tobacco product users. Ever use of heated tobacco products was uncommon among U.S. adults (0.51%) but more prevalent among E-cigarette users and cigarette smokers. In the general adult populations, the odds of ever use of heated tobacco products were significantly higher among cigarette smokers (AOR=2.19, 95% CI=1.63, 2.94), E-cigarette smokers (AOR=2.70, 95% CI=1.71, 4.25), and other tobacco product users (AOR=1.69, 95% CI=1.30, 2.20). CONCLUSIONS Although the ever use of heated tobacco products is uncommon among U.S. adults, recent regulatory approval of the marketing of IQOS as modified risk tobacco products may increase use. Therefore, ongoing monitoring of heated tobacco products use and their long-term health consequences are important for informing future decision making.
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Gottschlich A, Mus S, Monzon JC, Thrasher JF, Barnoya J. Cross-sectional study on the awareness, susceptibility and use of heated tobacco products among adolescents in Guatemala City, Guatemala. BMJ Open 2020; 10:e039792. [PMID: 33318112 PMCID: PMC7737060 DOI: 10.1136/bmjopen-2020-039792] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Heated tobacco products (HTPs) are increasingly marketed worldwide, yet limited research on HTPs has been conducted in low and middle-income countries (LMICs) or among adolescents. Guatemala is one of the few LMICs where HTPs are available. This study examined prevalence and correlates of HTP awareness, susceptibility and use among adolescents in Guatemala. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey on HTP awareness, susceptibility and use was conducted among 2870 students between the ages of 13 and 17 in private schools in Guatemala City, Guatemala. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was susceptibility to future use of HTP among school-aged current and never smokers in Guatemala. We also explored awareness and use of HTPs. Multivariate binomial regression models were used to explore associations between these outcomes and both sociodemographic factors and established smoking correlates. RESULTS Of all students (n=2870), about half were aware of HTPs (52.4%) and susceptible to future or continued use (52.4%). Whereas 8.4% of students had tried HTPs in the lifetime (but not in the last month), only 2.9% used HTPs in the past month. Independent correlates of HTP susceptibility and ever-use included: use of other tobacco products (current smoking: adjusted OR (AOR)=10.53 and 6.63, respectively; current e-cigarette use: AOR=21.87 and 10.40, respectively), moderate alcohol consumption (AOR=1.49 and 1.19, respectively), marijuana use in the past 30 days (AOR=3.49 and 2.29, respectively) and having friends who use HTPs (AOR=1.83 and 7.28, respectively). CONCLUSIONS Among this sample of adolescents in Guatemala City, where tobacco control is weak, the prevalence of HTP use was low but susceptibility to future use was high. Tobacco prevention and intervention strategies for cigarettes and e-cigarettes should now also include HTPs, which tend to be used by similar adolescent populations (ie, those who use other substances or are exposed to tobacco through family and friends).
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Affiliation(s)
- Anna Gottschlich
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sophia Mus
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
| | - Jose Carlos Monzon
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Joaquin Barnoya
- Instituto de Investigación y Estudios Superiores en Ciencias de la Salud, Universidad Rafael Landivar, Guatemala, Guatemala
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular, Guatemala, Guatemala
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Bolt HM. Electronic cigarettes and vaping: toxicological awareness is increasing. Arch Toxicol 2020; 94:1783-1785. [PMID: 32440856 PMCID: PMC7240249 DOI: 10.1007/s00204-020-02786-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Hermann M Bolt
- Department of Toxicology, Leibniz Research Centre for Working Environment and Human Factors at TU, Dortmund (IfADo), Ardeystr. 67, 44139, Dortmund, Germany.
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