United States: consumption and perception of risks of heated tobacco

In April 2019, the United States Food and Drug Administration announced the marketing authorization of the new heated tobacco product manufactured by Philip Morris. Following this authorization, a study, published in Tobacco Control[1], examined the consumption of these products and the perception of their risks in the United States compared to the perception of electronic cigarettes in the early 2010s.

The study analyzed responses from more than 20,000 U.S. adults who participated in an online survey between November 2019 and February 2020. The study compared data on consumption and perceptions of heated tobacco versus e-cigarettes, when the latter first gained public interest in the U.S. in the early 2010s.

Overall, 8.1% of respondents had heard of heated tobacco. Only 0.55% had tried the product and 0.10% were consumers at the time of the study. These figures are similar to those in 2017, before FDA approval. The majority of respondents considered heated tobacco to be less harmful than (11.6%) or as harmful as e-cigarettes (42.7%). Just over 1 in 10 respondents said heated tobacco was less harmful than e-cigarettes, while 42.7% thought it was equally harmful. Perceptions were broadly similar across all ages, except for older adults (65 and older), where a lower percentage said they had heard of the product.

Comparison with the use of electronic cigarettes in the 2010s

This low awareness appears at first glance to contrast with the very high awareness of e-cigarettes in the early 2010s. By 2012, about three-quarters of the U.S. population had heard of e-cigarettes. However, there are important similarities between the early adoption pattern of heated tobacco and e-cigarettes. The study results are good indicators of future product adoption: of those who had heard of heated tobacco, about 7% tried a heated tobacco product, while 18% who tried a heated tobacco product became regular users. By comparison, in 2012, 11% of those who had heard of e-cigarettes tried the product, and 18% who tried it became regular users.

In short, once someone has some experience with these products, the likelihood of becoming a continuing user is the same, about one in five for either product.

Tobacco industry marketing could change the situation

This study, carried out in the wake of the public agency's decision, probably explains the overall lack of awareness of this product and its low use. However, this situation could quickly change given the marketing deployed to promote these products. The distribution of heated tobacco in the United States is currently limited to a single brand, although other brands have also been sold without authorization from the public agency. Following the FDA's decision in April 2019, Philip Morris began marketing its product first in Atlanta (October 2019) and then in Richmond (November 2019). The ban on advertising in traditional media led the manufacturer to develop its actions mainly in points of sale, which remain numerous. Once the national deployment is envisaged with established distribution channels, consumption is expected to grow and spread significantly.