2. HTP prevalence in England and use for smoking cessation

To regulate HTPs appropriately, policy makers should understand their impact on health, cigarette smoking cessation, and smoking prevalence. This talk will cover the recent Cochrane systematic review into these effects, as well as data on the prevalence of HTP use in England

The Cochrane review included randomised controlled trials (RCTs) in which people were randomised to switch to exclusive HTPs use or a control condition were included. Time-series studies were also eligible if they examined the population-level impact of HTPs on cigarette smoking prevalence or sales. Estimates of HTP prevalence came from cross-sectional surveys in England up to 2021 (STS, ASH).

In England, an estimated 0.3% (STS) or 0.5% (ASH) of adults currently use HTPs. The Cochrane review identified no studies reporting cigarette smoking cessation, so the effectiveness of HTPs for this purpose remains uncertain. It found insufficient evidence for differences in risk of adverse/serious adverse events between people randomised to switch to HTPs, smoke cigarettes, or attempt abstinence from all tobacco. There was moderate-certainty evidence that HTP users have lower exposure to toxicants/carcinogens than cigarette smokers and very low- to moderate-certainty evidence of higher exposure than those attempting abstinence from all tobacco. All RCTs identified were funded by tobacco companies. The rate of decline in cigarette sales accelerated after the introduction of HTP to market in Japan, but this may not be causal.

HTP use remains rare in England. HTPs appear to exposure users to fewer toxicants/carcinogens than cigarettes, but more independent evidence is needed on smoking cessation and adverse events.