Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic Review

Introduction: Relative or absolute safety of heated tobacco products (HTPs) remains unknown, while independent literature suggests that these products do not favor tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP u...

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Main Authors: Marco Scala, Giulia Dallera, Giuseppe Gorini, Jérémie Achille, Anne Havermans, Clara Neto, Anna Odone, Luc Smits, Antonella Zambon, Alessandra Lugo, Silvano Gallus
Format: Article
Language:English
Published: Japan Epidemiological Association 2025-05-01
Series:Journal of Epidemiology
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Online Access:https://www.jstage.jst.go.jp/article/jea/35/5/35_JE20240189/_pdf
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author Marco Scala
Giulia Dallera
Giuseppe Gorini
Jérémie Achille
Anne Havermans
Clara Neto
Anna Odone
Luc Smits
Antonella Zambon
Alessandra Lugo
Silvano Gallus
author_facet Marco Scala
Giulia Dallera
Giuseppe Gorini
Jérémie Achille
Anne Havermans
Clara Neto
Anna Odone
Luc Smits
Antonella Zambon
Alessandra Lugo
Silvano Gallus
author_sort Marco Scala
collection DOAJ
description Introduction: Relative or absolute safety of heated tobacco products (HTPs) remains unknown, while independent literature suggests that these products do not favor tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP use on conventional tobacco smoking (use transitions). Methods: We used Pubmed/MEDLINE, Embase, and the Cochrane Library to identify all articles published up to February 2022 on HTP use. For the present review, we included all representative cross-sectional studies dealing with HTP use, and all prospective cohort studies or cross-sectional studies on conventional tobacco smoking transitions due to HTP use. From 610 non-duplicate articles, 76 were eligible (71 cross-sectional and 5 prospective cohort studies). Results: Compared with young adults, HTP use was less frequent among middle-aged (15 studies; pooled odds ratio [OR] 0.59; 95% confidence interval [CI], 0.48–0.74) and older adults (12 studies; OR 0.17; 95% CI, 0.07–0.38). HTP use was more frequent among former (6 studies; OR 2.73; 95% CI, 1.03–7.25) and current smokers (12 studies; OR 14.53; 95% CI, 6.34–33.31). Overall, 68.3% of HTP users were dual users (n = 26). Eight studies (including 5 cohorts) showed that HTP users were more likely than non-users to start conventional cigarette smoking (2 studies; OR 6.31; 95% CI, 4.13–9.65), whereas current cigarette smokers using HTPs were less likely to quit (4 studies; OR 0.84; 95% CI, 0.80–0.89). Conclusion: We found that HTPs are specifically popular among young generations. More than two out of three HTP users are dual users. Prospective studies consistently show that, in real life, HTPs are not effective smoking-cessation tools.
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publishDate 2025-05-01
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spelling doaj-art-29339ea74fc6459f881f9c005dcc3ed72025-08-20T03:11:21ZengJapan Epidemiological AssociationJournal of Epidemiology0917-50401349-90922025-05-0135521322110.2188/jea.JE20240189Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic ReviewMarco Scala0Giulia Dallera1Giuseppe Gorini2Jérémie Achille3Anne Havermans4Clara Neto5Anna Odone6Luc Smits7Antonella Zambon8Alessandra Lugo9Silvano Gallus10Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, ItalyDepartment of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, ItalyOncologic Network, Prevention and Research Institute (ISPRO), Florence, ItalyFrench Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, FranceCentre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The NetherlandsFrench Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, FranceDepartment of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, ItalyCare and Public Health Research Institute, Department of Epidemiology, Maastricht University, Maastricht, The NetherlandsDepartment of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, ItalyDepartment of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, ItalyDepartment of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, ItalyIntroduction: Relative or absolute safety of heated tobacco products (HTPs) remains unknown, while independent literature suggests that these products do not favor tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP use on conventional tobacco smoking (use transitions). Methods: We used Pubmed/MEDLINE, Embase, and the Cochrane Library to identify all articles published up to February 2022 on HTP use. For the present review, we included all representative cross-sectional studies dealing with HTP use, and all prospective cohort studies or cross-sectional studies on conventional tobacco smoking transitions due to HTP use. From 610 non-duplicate articles, 76 were eligible (71 cross-sectional and 5 prospective cohort studies). Results: Compared with young adults, HTP use was less frequent among middle-aged (15 studies; pooled odds ratio [OR] 0.59; 95% confidence interval [CI], 0.48–0.74) and older adults (12 studies; OR 0.17; 95% CI, 0.07–0.38). HTP use was more frequent among former (6 studies; OR 2.73; 95% CI, 1.03–7.25) and current smokers (12 studies; OR 14.53; 95% CI, 6.34–33.31). Overall, 68.3% of HTP users were dual users (n = 26). Eight studies (including 5 cohorts) showed that HTP users were more likely than non-users to start conventional cigarette smoking (2 studies; OR 6.31; 95% CI, 4.13–9.65), whereas current cigarette smokers using HTPs were less likely to quit (4 studies; OR 0.84; 95% CI, 0.80–0.89). Conclusion: We found that HTPs are specifically popular among young generations. More than two out of three HTP users are dual users. Prospective studies consistently show that, in real life, HTPs are not effective smoking-cessation tools.https://www.jstage.jst.go.jp/article/jea/35/5/35_JE20240189/_pdfheated tobacco productsheat-not-burn tobaccodual usepublic healthmeta-analysis
spellingShingle Marco Scala
Giulia Dallera
Giuseppe Gorini
Jérémie Achille
Anne Havermans
Clara Neto
Anna Odone
Luc Smits
Antonella Zambon
Alessandra Lugo
Silvano Gallus
Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic Review
Journal of Epidemiology
heated tobacco products
heat-not-burn tobacco
dual use
public health
meta-analysis
title Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic Review
title_full Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic Review
title_fullStr Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic Review
title_full_unstemmed Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic Review
title_short Patterns of Use of Heated Tobacco Products: A Comprehensive Systematic Review
title_sort patterns of use of heated tobacco products a comprehensive systematic review
topic heated tobacco products
heat-not-burn tobacco
dual use
public health
meta-analysis
url https://www.jstage.jst.go.jp/article/jea/35/5/35_JE20240189/_pdf
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