1. Global Prevalence of Heated Tobacco Product Use: A Systematic Review and Meta-analysis

Heated tobacco products (HTP) are electronic devices that heat tobacco to release aerosols, including nicotine and other chemicals when inhaled. HTP are marketed as a harm reduction strategy as part of the latest efforts by tobacco companies to increase industry profits. After the successful launch of HTP in Japan 2014, traditional tobacco industries have penetrated their HTP to other countries, such as Korea and Italy. Sales of HTPs are increasing; however, there is limited data on the extent of HTP use patterns globally. The objective of this study was to estimate the findings of epidemiological studies that report the prevalence of HTP use by country, survey year, age, and gender.

We searched five databases; EMBASE, PubMed, Scopus, PsycINFO and Web of Science (from January 1, 2010, to November 23, 2021) for English language studies that reported the prevalence of HTP use among adolescents and adults. Observational, quantitative, nationally representative, and peer reviewed studies providing estimates for lifetime, 30-day or daily HTP use were selected. Study characteristics and prevalence estimates were extracted from each article and was conducted independently by four reviewers, using a standardised data extraction sheet.

Out of 3547 initially identified records, 74 studies met our inclusion criteria, representing 39 countries, between the year 2015 and 2020. Most prevalence data was reported from Japan (25/74), Korea (18/74), the United States of America (10/74), the United Kingdom (8/74) and Hong Kong (5/74). Large, nationally representative surveys, such as the Korea Community Health Survey and Korea Youth Risk Behaviour Survey found that 7.6% of Korean adults (N= 229,045) and 4.7% of Korean adolescents (N= 57,303) reported HTP lifetime use in 2019, respectively.

HTP represent the latest products that tobacco companies have marketed as less dangerous than conventional cigarettes. Based on the available studies, most originated from Japan and Korea, where HTP are marketed aggressively and imply that they are safer than cigarettes. Given the interests of the tobacco industry in HTP, growth in prevalence is likely and warrants additional regulation.