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Early adoption of heated tobacco products resembles that of e-cigarettes
  1. Shu-Hong Zhu1,2,
  2. Julian Ong2,
  3. Shiushing Wong2,
  4. Adam Cole3,
  5. Yue-Lin Zhuang2,
  6. Yuyan Shi4
  1. 1 Herbert Wertheim School of Public Healh, University of California San Diego, La Jolla, California, USA
  2. 2 Moores Cancer Center, University of California San Diego, La Jolla, California, USA
  3. 3 Faculty of Health Science, University of Ontario Institute of Technology Faculty of Health Sciences, Oshawa, Ontario, Canada
  4. 4 Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, California, USA
  1. Correspondence to Dr Shu-Hong Zhu, University of California San Diego, La Jolla, CA 92093, USA; szhu{at}


Background Heated tobacco products (HTP) generate nicotine-containing aerosol by heating tobacco rather than burning it. The US Food and Drug Administration (FDA) has recently authorised the sale of one HTP brand, iQOS, in the USA. This study examined the awareness, use and risk perceptions of HTP in the USA following FDA authorisation.

Methods A national probability sample of 20 449 US adults completed an online survey between November 2019 and February 2020. In addition to assessing awareness and use of HTP, two ratios were calculated: the ratio of those who experimented with HTP given that they had heard about it (E/H) and the ratio of those who currently used HTP given experimentation (C/E). These ratios for HTP were compared against those for e-cigarettes from a similar national survey in 2012.

Results Overall, 8.1% of respondents had heard of HTP. Only 0.55% had tried and 0.10% were current users. The rate of experimentation among those who heard about HTP and the rate of current use among experimenters were, however, similar to those for e-cigarettes in 2012: E/H and C/E for HTP were 6.8% and 18.2%, respectively; and 10.7% and 17.8%, respectively for e-cigarettes. The majority of respondents considered HTP either less harmful than (11.6%), or equally harmful as e-cigarettes (42.7%).

Conclusions Only a small fraction of US population in 2020 have tried any HTP. However, the similarity in early adoption rates following awareness, suggests that future adoption for HTP may be similar to that for e-cigarettes, if HTP are marketed more aggressively.

  • non-cigarette tobacco products
  • public opinion
  • public policy

Data availability statement

Data are available on reasonable request from YS (

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Data availability statement

Data are available on reasonable request from YS (

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  • Contributors S-HZ, JO and Y-LZ. Study Design: S-HZ, AC, Y-LZ and YS. Data analysis and interpretation: S-HZ, JO, SW and Y-LZ. Drafts: S-HZ and JO. Critical review and final version: S-HZ, JO, SW, AC, Y-LZ and YS.

  • Funding The Marijuana Use and Environment Survey were supported by grant R01DA042290 from the US National Institute on Drug Abuse (PI: Shi).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funders of this study had no role in the study design; collection, analysis, and interpretation of the data; writing of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests None declared.

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