Patterns of heated tobacco product use and biochemically verified smoking status among customers of dedicated heated tobacco product stores

To understand the population impact of heated tobacco products (HTPs), examining the profile of their users is crucial. This study aimed to assess the characteristics, patterns of HTP use, and biochemically verified smoking status of customers visiting specialized HTP stores in Greece. Two specialized stores selling IQOS HTPs were randomly selected in Athens. Researchers recruited consecutive adult customers purchasing products for personal use during store visits. Current smoking status was determined by measuring exhaled carbon monoxide (eCO), with ≥ 7 ppm classifying participants as current smokers. A questionnaire explored demographics, past and current smoking history, HTP use patterns, and dependence indicators. A total of 373 HTP users participated. The vast majority (98.1%) had a smoking history prior to HTP initiation, with 69.1% reporting being former smokers and having eCO < 7 ppm (classified as former smokers), while 30.9% remained current smokers (dual users). Current smokers reported a significant 50% median reduction in daily cigarette consumption after starting HTP use (P < 0.001). Only 1.9% of the sample were never-smokers, all of whom had eCO ≤ 3 ppm. Daily HTP use was the predominant pattern of use in both groups, but was more prevalent among former smokers. Additionally, former smokers reported longer HTP use duration and higher indicators of past cigarette and current HTP dependence compared to current smokers. Most participants perceived HTPs as less harmful than cigarettes. Customers of specialized HTP stores in Greece are predominantly individuals with a history of smoking, a substantial majority of whom have stopped smoking after initiating HTP use. Use by never-smokers appears rare in this retail setting, and does not lead to subsequent smoking.