Switching and substantial reductions in cigarette consumption concurrent with use of a heated tobacco product among adults who smoke in Czechia: an actual use study.

Background: The potential for heated tobacco products (HTPs) to reduce smoking-related harm depends, in part, on how adults who smoke cigarettes use HTPs in their everyday lives, and the extent to which HTPs come to be used as a replacement for all or most of the cigarettes that a person smokes. This study assessed changes in cigarette smoking behaviour among adults who smoke when using HTPs in near-to-real world settings for six weeks.

Methods: Participants were 332 adults aged 19 years and older who smoked between 5 and 30 cigarettes per day, on average, living in Prague or Brno, Czechia, who reported no intention to quit smoking within the next three months but reported a positive likelihood of using the PULZE + iD Heated Tobacco System ('the Study Product') on a regular basis following a brief trial use period. Participants were given a personal prepaid debit card to purchase packs of consumable heated tobacco sticks ('iD Sticks', the Study Sticks) in their choice of 12 commercially available flavours, directly from retailers in the community, to use as desired for six weeks. Participants recorded their daily consumption of cigarettes, Study Sticks, and other tobacco products in an electronic diary for 42 consecutive days. Data were collected between May-November 2023.

Results: During Week-6 of ad libitum use of the Study Product, 16.0% of participants had completely switched from cigarettes to the Study Product (i.e., past 7-day use of the Study Product and zero cigarettes smoked) and 33.7% had reduced their daily cigarette consumption by 50-99% while continuing to use the Study Product. On average, weekly cigarette consumption reduced by 35.6% (1.9 fewer packs per participant) during Week-1 and 45.2% (2.4 fewer packs per participant) during Week-6, compared to the pre-study baseline week. Most Study Sticks consumed during the Observational Phase were flavoured to taste like fruit (40.1%), followed by tobacco (38.4%) and menthol/mint (21.5%). At Week-24, 63.6% continued to purchase Study Sticks with their own money and 50.9% were using the Study Product as a complete or majority replacement for cigarettes.

Conclusions: The Study Product has potential to help adults who smoke to completely switch away from cigarettes or substantially reduce cigarette consumption in the short- to medium-term in real-world settings.