@article {Miller11, author = {Connor R Miller and Edward Sutanto and Danielle M Smith and Sara C Hitchman and Shannon Gravely and Hua H Yong and Ron Borland and Richard J O{\textquoteright}Connor and K Michael Cummings and Geoffrey T Fong and Andrew Hyland and Anne C K Quah and Maciej L Goniewicz}, title = {Awareness, trial and use of heated tobacco products among adult cigarette smokers and e-cigarette users: findings from the 2018 ITC Four Country Smoking and Vaping Survey}, volume = {31}, number = {1}, pages = {11--18}, year = {2022}, doi = {10.1136/tobaccocontrol-2020-055985}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective To evaluate heated tobacco product (HTP) awareness, trial and current use among adult cigarette smokers and vaping product users in four countries with varying regulations governing HTP sales.Design Data came from Wave 2 of the ITC Four Country Smoking and Vaping Survey, collected from February to July 2018. Respondents were current and former smokers and/or users of vaping products (18 years or older) from Canada (CA; n=3778), England (EN; n=4848), the USA (US; n=2846) and Australia (AU; n=1515). At the time of the survey, only Canada and England permitted the sale of contemporary HTPs (eg, IQOS).Results Overall, 30.2\% of respondents reported being aware of HTPs (CA=30.4\%; EN=31.0\%; US=30.2\%; AU=27.4\%; p=0.346), 2.4\% had ever tried HTPs (CA=3.3\%; EN=2.4\%; US=2.0\%; AU=0.9\%; p=0.001) and 0.9\% currently used HTPs at least monthly (CA=0.8\%; EN=1.2\%; US=0.7\%; AU=0.2\%; p\<0.001). Trial and current use were higher among those who concurrently smoked and vaped (at least monthly) versus other nicotine use categories (trial: 10.9\% v. 1.2\%{\textendash}2.0\%, p\<0.001; current use: 8.4\% v. 0.1\%{\textendash}1.0\%, p\<0.001). In multivariable analyses, HTP awareness did not differ across countries, whereas odds of trial and current use were lower where HTPs were unavailable. Odds of HTP trial did not differ by regulatory environment when restricting analysis to HTP-aware concurrent smokers{\textendash}vapers.Conclusion Approximately one third of respondents were aware of HTPs, even in the USA and Australia, where contemporary HTPs were not yet on the market. Trial and use were uncommon, except among concurrent smokers{\textendash}vapers. Restrictions on availability may have limited HTP use generally, but less so for concurrent smokers{\textendash}vapers.Data are available upon reasonable request.}, issn = {0964-4563}, URL = {https://tobaccocontrol.bmj.com/content/31/1/11}, eprint = {https://tobaccocontrol.bmj.com/content/31/1/11.full.pdf}, journal = {Tobacco Control} }