Study finds majority of heated tobacco users in Greek HTP stores are former smokers

Use by never-smokers remains rare, says research team

A new peer-reviewed study published in Internal and Emergency Medicine has found that the overwhelming majority of customers purchasing heated tobacco products (HTPs) at dedicated stores in Greece were either former or current smokers, with very few never-smokers taking up the products.

The research, led by the Department of Public and Community Health at the University of West Attica in Athens, assessed 373 adult users of IQOS products at two specialised HTP stores in the city. Through a combination of surveys and exhaled carbon monoxide (eCO) testing, the study aimed to better understand the profile and behaviour of heated tobacco users.

Crucially, 98.1 per cent of those surveyed had a smoking history prior to initiating HTP use. Of the total sample, more than two-thirds (67.8%) were verified as former smokers, defined by self-reporting and eCO levels below 7 parts per million. Among this group, 90.1 per cent said they had quit smoking with the help of HTPs.

Current smokers made up 30.3 per cent of the sample but reported a median 50 per cent reduction in their daily cigarette consumption since switching to heated tobacco. Daily HTP use was the dominant pattern among both former and current smokers, with even higher prevalence among the former.

Only 1.9 per cent of participants were never-smokers, all of whom had very low eCO readings (≤3 ppm), and there was no evidence of these individuals transitioning to combustible cigarettes. Most users perceived heated tobacco as less harmful than traditional smoking, a view that has become increasingly common among adult consumers globally.

Commenting on the findings, the authors highlighted that “use by never-smokers was rare in this retail setting and did not lead to subsequent smoking,” underscoring the role HTPs may play as harm-reduction tools for adult smokers.

Logistic regression analysis further showed that being a former smoker was significantly associated with longer duration of HTP use and daily use patterns – suggesting that regular engagement with the product was linked to higher cessation rates.

The study adds to a growing body of evidence suggesting that, in a retail environment geared towards adult smokers, heated tobacco products are primarily being used as alternatives by those looking to quit or cut down, rather than as a gateway for new users.