Awareness and use of heated tobacco products among adult smokers in six European countries: findings from the EUREST-PLUS ITC Europe Surveys
Authors: Maria Lotrean Lucia , Trofor Antigona , Radu-Loghin Cornel , Eremia Marius , Mihaltan Florin , Driezen Pete , Kyriakos Christina N , Mons Ute , Demjén Tibor , Fernández Esteve , Katsaounou Paraskevi A , Przewoźniak Krzysztof , Filippidis Filippos T , Gravely Shannon , Fong Geoffrey T , Vardavas Constantine I ,   the EUREST-PLUS Consortium, Vardavas Constantine I , Glahn Andrea , Kyriakos Christina N , Nguyen Dominick , Nikitara Katerina , Radu-Loghin Cornel , Starchenko Polina , Tsatsakis Aristidis , Girvalaki Charis , Igoumenaki Chryssi , Papadakis Sophia , Papathanasaki Aikaterini , Tzatzarakis Manolis , Vardavas Alexander I , Bécuwe Nicolas , Deaconu Lavinia , Goudet Sophie , Hanley Christopher , Rivière Oscar , Demjén Tibor , Kiss Judit , Kovacs Anna Piroska , Fernández Esteve , Castellano Yolanda , Fu Marcela , Nogueira Sarah O , Tigova Olena , McNeill Ann , East Katherine , Hitchman Sara C , Mons Ute , Kahnert Sarah , Tountas Yannis , Behrakis Panagiotis , Filippidis Filippos T , Gratziou Christina , Katsaounou Paraskevi , Peleki Theodosia , Petroulia Ioanna , Tzavara Chara , Trofor Antigona Carmen , Eremia Marius , Lotrean Lucia , Mihaltan Florin , Rohde Gernot , Asano Tamaki , Cichon Claudia , Far Amy , Genton Céline , Jessner Melanie , Hedman Linnea , Janson Christer , Lindberg Ann , Maguire Beth , Ravara Sofia , Vaccaro Valérie , Ward Brian , Willemsen Marc , de Vries Hein , Hummel Karin , Nagelhout Gera E , Zatoński Witold A , Herbeć Aleksandra , Janik-Koncewicz Kinga , Przewoźniak Krzysztof , Zatoński Mateusz , Fong Geoffrey T , Agar Thomas K , Driezen Pete , Gravely Shannon , Quah Anne C K , Thompson Mary E 
Published: May 2020

Abstract

Background
The study assessed awareness and use of heated tobacco products (HTPs) and factors that influenced these issues among cigarette smokers from six European countries in 2016 (Wave 1) and 2018 (Wave 2).

Methods
A survey was conducted among a nationally representative sample of cigarette smokers aged 18 years or older from Germany, Greece, Hungary, Poland, Romania and Spain in 2016 (N = 6011) and 2018 (N = 6027; 53% of smokers from the previous wave were retained, regardless of smoking status and dropouts were replaced by a replenishment sample of smokers). Data were collected through face-to-face interviews. Estimates were produced using weighted data. The study presents the cross-sectional results.

Results
Awareness of HTPs increased from 8% to 17% between the two waves. At Wave 1, 1.1% of the smokers declared having used HTPs at least once during their lifetime; and at Wave 2, this increased to 1.9% (around 1% or less in four countries, except for Greece and Romania where it was around 4%). Factors associated with HTPs use among those who had ever heard about these products at Wave 1 were country of residence, being a daily cigarette smoker and ever use of electronic cigarettes. At Wave 2, ever use of HTPs was significantly higher among those who had tried to quit smoking combustible cigarettes in the last 12 months, had tried electronic cigarettes during lifetime and perceived HTPs as less dangerous than combustible cigarettes; the country of residence was also associated with HTPs use.

Conclusion
This study offers insights into the behaviours and perceptions of European adult smokers regarding HTPs, an important emerging issue in the field of tobacco control.