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

Background: 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. Methods: 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. Results: 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. Conclusions: 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.