The Rise of Heated Tobacco Products Among Young Adults in Romania

In recent years, heated tobacco products (HTPs) have gained popularity globally as a supposed safer alternative to combustible cigarettes (CCs). However, their widespread adoption has raised concerns about their impact on public health. A closer look at the situation in Romania reveals a concerning trend: young adults aged 15 to 25 are among the highest users of HTPs.

According to data analyzed by age groups, the prevalence of HTPs usage is significantly higher among this age group compared to other age groups. Furthermore, a study comparing the prevalence of HTPs usage in 11 European countries found that Romania ranked second after Greece, with 3% of participants being ever users and 1.3% declaring current use.

The increased awareness and use of HTPs among European cigarette smokers has been identified as a significant trend over the past two years. In Romania, IQOS and glo are the two brands of HTPs currently available in the market, introduced locally in 2020 and 2019 respectively.

The Romanian legislation allows for indoor smoking only if the tobacco is burned, effectively permitting the use of HTPs indoors. This has contributed to their popularity among young adults who seek a safer alternative to CCs.

However, there are concerns about the marketing strategies employed by HTP manufacturers to target this demographic. Despite strict regulations on advertising for CCs at the European level, the implementation of EU Directives varies significantly from country to country, resulting in different levels of control over HTP marketing.

Young adults' decision to use HTPs appears to be influenced by a cluster of factors including overcoming the legislation gap that prohibits indoor use of CCs but not HTPs, product attractivity (novelty, inviting appearance, technological appeal, and price), and presumed less damaging effects on health.

A thematic analysis conducted for this study identified three overarching themes: people, places, and subjects of marketing; engagement with risk narratives; and social body, family bonds, and autonomous self. Interviews with smokers of HTPs or CCs and non-smokers aged 18-26 revealed the influence of direct marketing methods on young people's perception and behavior towards smoking.

The rapid uptake of HTPs among young people in Romania is particularly concerning due to the lack of regulation over advertising in the country. As policymakers consider strategies to address this issue, it is essential to recognize the complex factors driving young adults' decision to use HTPs and to develop effective measures to counteract their influence.

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