BACKGROUND AND AIM: Heated tobacco products (HTPs) are electronic devices that heat processed tobacco to release an aerosol containing nicotine and other chemicals. Limited data exist on worldwide HTP use prevalence. This meta-analytic review estimated the prevalence of HTP use by country, WHO region, year, sex/gender, and age.

METHODS: Five databases (Web of Science, Scopus, Embase, PubMed, and PsycINFO) were searched between January 2015 and May 2022. Included studies reported the prevalence of HTP use in nationally representative samples post-modern HTP device market entry (2015). A random effects meta-analysis was used to estimate overall prevalence for lifetime, current, and daily HTP use.

RESULTS: Forty-five studies (n=1,096,076) from 42 countries/areas from the European Region (EUR), Western Pacific Region (WPR), Region of the Americas (AMR) and African Region (AFR) met inclusion criteria. Estimated pooled prevalence for lifetime, current and daily HTP use was 4.87%, 1.53%, and 0.79%, respectively, across all years (2015-2022). Lifetime HTP use prevalence significantly increased by 3.39% for WPR (0.52% in 2015 to 3.91% in 2019) and 5.58% for EUR (1.13% in 2016 to 6.98% in 2020). Current HTP use increased by 10.45% for WPR (0.12% in 2015 to 10.57% in 2020) and 1.15% for EUR (0% in 2016 to 1.15% in 2020). Meta-regression revealed higher current HTP use in WPR (3.80%[95%CI:2.88,4.98]) compared with EUR (1.40%) and AMR (0.81%), and for males (3.45%) compared with females (1.82%). Adolescents had higher lifetime HTP use prevalence (5.25%) than adults (2.45%). Most studies scored a low risk of sampling bias due to their nationally representative sampling.

CONCLUSION: The prevalence of heated tobacco products (HTP) use increased in the European and Western Pacific Regions between 2015 and 2020, with nearly 5% of the included populations having ever tried HTP and 1.5% identifying as current users during the study period.