Considering the tobacco harm reduction equation, two factors are equally important to have a positive impact in terms of tobacco harm reduction on population health. First is the product, which assessment must show presents less risk of harm for those who switch to it rather than continuing to smoke cigarettes. Second, many adult smokers who would otherwise continue to smoke — the intended group of users for this product — should switch to it.
There’s more to the second part of the harm reduction equation than meets the eye. Not only is it important to encourage intended users to pick up a smoke-free product and stick with it, but it’s equally important to minimize use by unintended users. That includes never smokers, former smokers, and youth.
To assess the impact of heated tobacco products on public health, we need information about whether unintended groups of people are using heated tobacco products. Based on the data that have been collected on adult smokers in Japan, Italy, and the U.S., the U.S. Food and Drug Administration concluded that “Available data, while limited, also indicate that few non-tobacco users would be likely to choose to start using [the Tobacco Heating System, THS], including youth.”
Now that heated tobacco, including our own THS, has been available in multiple countries for a few years, data on that point is becoming available. Because we don’t conduct research involving participants under the legal age for tobacco use, we need to rely on the data and conclusions reported by the global scientific community to understand whether youth are using heated tobacco products. Here’s an overview of some of the key results so far.
The 2017 Lifestyle Survey of Adolescents, a nationwide cross-sectional survey of Japanese youth was conducted with support from a grant for Comprehensive Research on Lifestyle-Related Diseases including Cardiovascular Diseases and Diabetes Mellitus by the Ministry of Health and Welfare Health Science Research Fund in Japan. The survey included answers from 64,152 students aged 12-18 years old. The students took the survey between December 2017 and February 2018.
According to the survey report, 0.6% of junior high school students and 1.5% of high school students smoke cigarettes monthly. 0.1% and 0.5% smoke daily, respectively, and 2.6% and 5.1% have ever smoked cigarettes. Compared to this, regular use of heated tobacco products is lower at 0.5% and 0.9% of students as monthly users while 0.1% of both age groups were daily users of heated tobacco products. In addition, 1.1% of surveyed junior high school and 2.2% of high school students have reported any experience with heated tobacco products.
The authors of the report also note that the number of users of heated tobacco products is growing. However, considering that heated tobacco products were first introduced only a few years before the survey was conducted, some increase however small is not unexpected.
The Federal Center for Health Education in Germany conducted the 2019 Drug Affinity Study, which included questions about the consumption of cigarettes, heated tobacco products, waterpipes (or hookahs), e-cigarettes, and e-hookahs. The survey sampled just over 7,000 adolescents and young adults between the ages of 12 and 25 using computer-aided telephone interviews. The data showed that, in 2019, a total of 7.2% of all 12 to 17-year-olds smoked, while 83.0% have never smoked.
In comparison, 0.5% of 12 to 17-year-olds have used a heated tobacco product at least once and 0.1% have used a heated tobacco product at least once in the past 30 days, which the report considers as “current users” of heated tobacco. Prevalence of heated tobacco product use is lower than that of the use of waterpipes (20.9% used at least once; 7.7% in the past 30 days), e-cigarettes (14.5% used at least once; 4.1% in the past 30 days), and e-hookahs (11.0% used at least once; 2.3% in the past 30 days) among the same age group.
Addiction Switzerland, an independent foundation and national center of competence in addictions research, released the results of the 2018 Health Behavior in School-aged Children study (published in 2019). Conducted every four years in over 40 countries, the study included results from Switzerland. 11,121 adolescents aged 11 to 15 years old took the pencil and paper survey during school hours.
Even though the majority of the survey focused on cigarettes and e-cigarettes, the study found that 1.7% of surveyed students aged 15 had used heated tobacco products at least once, and 1.1% reported using heated tobacco products in the past 30 days. Less than 2% of 14- to 15-year-olds report ever using heated tobacco products. These statistics for heated tobacco product prevalence among youth are lower than for cigarettes, which 2% to 5.7% of 11-year-olds and 29.8% to 35.4% of 15-year-olds have tried, and which 3.5% to 5.6% of 15-year-olds smoked on a daily basis.
In the studies presented above, there’s a clear trend of limited prevalence among youth. Heated tobacco products are used by around 2% or less of the students among those surveyed in various geographically diverse countries. The percentage in each case is lower than cigarettes or e-cigarettes. Even so, we are committed to bringing those numbers as close to zero as possible. What these data tell us is that we need to remain vigilant, and to maintain our strong efforts to keep heated tobacco products out of the hands of minors.