- Most heated tobacco product (HTP) users polled (67.8%) were verified former smokers, confirmed via carbon monoxide breath tests
- Of these, 90.1% said HTPs helped them quit cigarettes entirely
- Daily HTP users were nearly seven times more likely to have quit smoking compared to occasional users
- Among those who still smoked, HTP use was associated with a 50% median reduction in daily cigarette consumption
Nearly seven in 10 adult users of heated tobacco products (HTPs) in a Greek study were verified former smokers – and almost all said HTPs helped them quit.
The study, published in Internal and Emergency Medicine, found that 67.8 per cent of participants were former smokers, confirmed both by self-report and carbon monoxide breath testing. Of those, 90.1 per cent credited HTPs with helping them stop smoking entirely.
Daily use of HTPs (devices that heat rather than burn tobacco) was strongly associated with quitting smoking. According to the study, daily users were nearly seven times (6.88 times) more likely to have stopped smoking than occasional users, and each additional month of use further increased the odds of cessation.
The study said: “daily use of HTPs was associated with higher odds of being a former smoker.”
The research, conducted in two specialist HTP stores in Athens, surveyed 373 adult customers between March and December 2019. Participants underwent exhaled carbon monoxide (eCO) tests to verify their smoking status, with levels below seven parts per million indicating they were non-smokers.
Among all users surveyed, 98.1 per cent had some history of smoking, while only 1.9 per cent were never-smokers. The vast majority of those with a smoking history had either quit or significantly reduced their cigarette consumption after starting to use HTPs. Among the 30.3 per cent who still smoked, the study found a median 50 per cent reduction in daily cigarette use.
The authors said: “A substantial proportion was biochemically verified former smokers and reported they had quit with the help of HTPs.”
One of few studies to verify smoking status
They added that this is one of the few studies to verify smoking status with biochemical measures rather than relying solely on self-report.
HTPs work by heating processed tobacco to release a nicotine-containing aerosol without combustion. While not risk-free, this method significantly reduces the levels of harmful chemicals compared to cigarette smoke.
Never-smokers in the study showed minimal and cautious use of HTPs. All had low eCO levels (≤3 ppm) and most used the products only occasionally rather than daily. Most said they believed HTPs were less harmful than cigarettes.
Perception of relative risk was consistent across the sample. “None of the respondents considered HTPs to be more harmful than cigarettes,” the authors wrote. They said “most considered them less harmful,” regardless of smoking status.
A meaningful role in smoking cessation
The study’s findings suggest that HTPs can play a meaningful role in smoking cessation or reduction for adult smokers, especially when sold in dedicated environments. The authors pointed out that specialist HTP shops, which are similar to vape shops, may appeal to smokers who are motivated to switch.
“Users frequenting such stores may represent a self-selected group already further along the switching pathway,” they wrote.
The study adds to a growing body of evidence that HTPs are mostly used by current or former smokers, not never-smokers, which is a key concern in tobacco harm reduction debates.
While long-term studies are still needed, the authors say their findings support the potential role of HTPs as lower-risk alternatives for smokers who are unable or unwilling to quit nicotine entirely.
