28 May 2020

Considering the tobacco harm reduction equation, two factors are equally important to have a positive impact on population health. One is the product, which assessment must show presents less risk of harm for those who switch to it rather than continuing to smoke cigarettes. The other is that many adult smokers who would otherwise continue to smoke should switch to it. That is the intended group of users for these products.

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.

As part of tracking the impact heated tobacco products have on public health, we need information about whether unintended groups of people are using heated tobacco products. Based on what data 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 [Platform 1], including youth.

Now that heated tobacco, including our own Platform 1, 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.

 

Japan graphic

In Japan: around 0.5%-0.9% of middle- and high school students report monthly heated tobacco use

A cross-sectional nationwide survey of Japanese youth was conducted in the framework of a Health and Labor Sciences Research Grant. The survey included answers from 64,329 students approximately 12-18 years old, who took the survey between December 2017 to the end of February 2018.

According to the survey report, 0.6% of middle school students and 1.5% of high school students smoke cigarettes monthly. 0.1% and 0.5% smoke daily, respectively. 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 middle 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 have increased since 2014. However, considering that 2014 was the same year when heated tobacco products were first introduced on a very limited scale and nationwide launch had happened only during the second half of 2015 to the country, some increase however small is not unexpected. 

Germany graphic

From Germany: less than 0.1% of youth reported past 30-day use

The Federal Center for Health Education in Germany conducted the Alcohol Survey 2018, which includes 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 2018, a total of 8.7% of all 12-17 year-olds smoke, while 79.5% have never smoked.

In comparison, 0.3% of 12-17 year-olds have used a heated tobacco product at least once. Among the same age group 0.1% used a heated tobacco product in the past 30 days at the time of the survey, which the report considers as “current users” of heated tobacco. These numbers trailed behind waterpipes (26.4% used at least once; 10.2% in the past 30 days), e-cigarettes (14.% used at least once; 5.1%  in the past 30 days), and e-hookahs (16.2% used at least once; 4.2% in the past 30 days) among the same age group.

Switzerland graphic

Swiss youth: less than 2% report past 30-day use

Addiction Switzerland, an independent foundation and national center of competence in addictions research, released the Swiss results of the Health Behavior in School-aged Children study in 2019, conducted every four years in over 40 countries. 11,121 adolescents aged 11 to 15 years old took the pencil and paper survey during school hours. The numbers in the next section are discussed as ranges because the study split the data between boys and girls, with boys generally using each product at a higher percentage than girls.

The majority of the survey focused on cigarettes and e-cigarettes among nicotine containing products, but the study did find that less than 2% of surveyed children aged 15 had used heated tobacco products at least once, and only a few students included in the sample had reported using heated tobacco in the past 30 days. That’s compared to cigarettes, which 2%-5.7% of 11-year-olds and 29.8%-35.4% of 15-year-olds have tried, and which 3.5%-5.6% of 15-year-olds smoked on a daily basis.

Global evidence shows ~2% or less of youth use heated tobacco

In the studies presented above, there’s a clear trend that heated tobacco products are used by around 2% or less of the students among those surveyed in multiple countries. Even though the percentage in each case was lower than that of both cigarettes and e-cigarettes, 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 strong efforts to keep heated tobacco products out of the hands of minors.