Heated tobacco product use and associated factors among U.S. youth, 2019

In April 2019, the U.S. Food and Drug Administration authorized the marketing of IQOS Heated Tobacco Products (HTPs) in the United States. This study sought to assess self-reported awareness and use of HTPs among U.S. students in 2019.

This study analyzed the 2019 National Youth Tobacco Survey (NYTS), a cross-sectional, school-based, nationally representative survey (n = 19,018). Weighted estimates of the prevalence of self-reported awareness, ever use, and current use (past 30-day) of HTPs were reported and multivariable logistic regression models were performed to examine the factors associated with HTPs awareness and use.

In 2019, 12.8 % (a population estimate of 3,438,000), 2.4 % (632,000), and 1.6 % (425,000) of U.S. students reported awareness, ever use, and current use of HTPs, respectively. In the multivariate analysis, high school students were less likely than middle school students to report awareness (AOR = 0.7 [0.6-0.8]) of HTPs. Females (vs. males) had a lower odd of reporting ever use of HTPs (AOR = 0.5 [0.4-0.8]), while Hispanics (vs. non-Hispanic Whites) had higher odds of reporting current use of HTPs (AOR = 1.6 [1.1-2.5]). Current cigarette smoking, e-cigarette use, and other tobacco use are associated with higher odds of HTPs ever and current use than non-users.

HTP use is emerging among U.S. adolescents. This study identified an elevated risk of HTP use among middle school students, Hispanics, current tobacco users, and those who live with a household member using HTPs. Continuous surveillance and educational campaigns on the harmfulness of HTPs are warranted.