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Awareness and use of heated tobacco products among US adults, 2016–2017
  1. Amy L Nyman1,
  2. Scott R Weaver1,2,
  3. Lucy Popova1,3,
  4. Terry Frank Pechacek1,4,
  5. Jidong Huang1,4,
  6. David L Ashley1,5,
  7. Michael P Eriksen1,4
  1. 1 School of Public Health, Tobacco Center of Regulatory Science (TCORS), Georgia State University, Atlanta, Georgia, USA
  2. 2 Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA
  3. 3 Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, Georgia, USA
  4. 4 Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, Georgia, USA
  5. 5 Division of Environmental Health, School of Public Health, Georgia State University, Atlanta, Georgia, USA
  1. Correspondence to Amy L Nyman, Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA 30302, USA; anyman{at}


Introduction Although heated tobacco products (HTP) have been on and off the commercial market for the past three decades (eg, Premier, Eclipse and Accord), they have not received widespread consumer acceptance as an alternative to combustible cigarettes. This may change with recent product innovations, shifts in consumer preferences and the tobacco market landscape and a US regulatory environment that may permit an internationally available HTP to be sold in the USA, possibly with a reduced exposure or risk statement. This study examined the extent of awareness and use of HTP in the USA and assessed the characteristics of those aware of and using these products.

Methods Data came from the 2016 and 2017 Tobacco Products and Risk Perceptions Surveys of national probability samples of US adults, conducted online during September–October 2016 (n=6014) and August–September 2017 (n=5992). Weighted χ2 tests and regression analyses examined changes in awareness and use of HTP between 2016 and 2017 and characteristics associated with awareness and use.

Results From 2016 to 2017, awareness of HTP among US adults increased from 9.3% to 12.4% (p<0.001), ever use increased from 1.4% to 2.2% (p=0.005) and current use increased two fold, from 0.5% to 1.1% (p=0.004). Men and adults under age 45 years had higher rates of awareness than women and those 45 and older, respectively. Non-white adults, cigarette smokers and both current and former users of electronic nicotine delivery systems were more likely to be using HTP.

Conclusions Awareness and use of HTP in the USA are increasing. These products are more familiar to men and younger adults and may be being used disproportionately by racial/ethnic minorities. With increases in HTP availability and the potential for reduced-risk claims ahead, surveillance of patterns and consequences of use by both smokers and non-smokers is needed.

  • non-cigarette tobacco products
  • public policy
  • surveillance and monitoring

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  • Contributors All authors conceptualised the study and approved the final version of the manuscript. ALN ran the analyses, wrote the first draft of the manuscript and revised subsequent drafts. SRW and JH provided statistical guidance, interpretation of results and contributed to writing, reviewing and revising drafts of the manuscript. LP, TFP, and DLA contributed to interpretation of results, writing, reviewing and revising drafts of the manuscript. MPE oversaw design of the parent study, reviewed manuscript drafts and provided feedback on analyses and revisions.

  • Funding This work was supported by the National Institute on Drug Abuse and The Food and Drug Administration (FDA) Center for Tobacco Products (CTP) (grant number P50DA036128).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

  • Competing interests MPE receives unrestricted research funding support from Pfizer, Inc (’Diffusion of Tobacco Control Fundamentals to Other Large Chinese Cities' MPE, Principal Investigator). DLA has received funds for work done for the World Health Organization Tobacco Free Initiative and as a Special Government Employee of the US Food and Drug Administration.

  • Patient consent Not required.

  • Ethics approval Both surveys were approved by the Georgia State University Institutional Review Board, who granted a waiver of informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Per the data sharing agreement with the NIH, the data that support the findings of this study will be made publicly available via a third-party data repository upon conclusion of the grant funding period. The data are also available from the principal investigator (MPE) on reasonable request.