Research News

Mar 24, 2023

Heated tobacco products make SARS‑CoV‑2 infection and severe COVID‑19 more likely

Study found users of heated tobacco product were more likely to contract SARS‑CoV‑2 and require hospitalization or oxygen

Using heated tobacco product makes severe COVID-19 more likely

An Osaka Metropolitan University research group found that users of heated tobacco products have a significantly higher rates of SARS-CoV-2 infection compared to non-tobacco users. Furthermore, the research group found that among tobacco users, those who used both heated tobacco products and traditional cigarettes reported the highest incidence of severe illness due to COVID-19.

Heated tobacco products—an alternative to traditional cigarettes, similar to e-cigarettes or vapes—do not burn tobacco leaves, but rather allow users to inhale the vapor produced by heating the tobacco leaves. Users choose heated tobacco products to avoid the smoke and odor of burnt tobacco as well as the expectation that they pose fewer health risks than traditional cigarettes. However, the long-term health effects of heated tobacco products, particularly the new risk of SARS-CoV-2 infection, have not been clarified.

Addressing this concern, a research group led by Associate Professor Kazuhisa Asai from the Osaka Metropolitan University Graduate School of Medicine conducted a study focusing on the relationship between using heated tobacco products and SARS-CoV-2 infection.

The research group investigated the relationship between tobacco use, including heated tobacco products and traditional cigarettes with SARS-CoV-2 infection and possible exacerbations of COVID-19. They administered an online survey of living conditions in February 2022 to 30,130 participants aged 16-81 years, who were randomly selected from the general population through an online survey according to a representative distribution, and conducted further statistical analyses.

From their analysis, the research group found that users of heated tobacco products–including both people who use them exclusively or in combination with traditional cigarettes—had significantly higher rates of COVID-19 compared to non-users. Furthermore, among all tobacco users, those who used both heated tobacco products and traditional cigarettes had the incidence of severe illness—requiring hospitalization or oxygen due to COVID-19.

“This study shows that the use of heated tobacco products may have an impact on SARS-CoV-2 infections and disease progression. We hope this report will encourage people to think about tobacco use in the context of the added risks due to coronavirus infection,” Professor Asai concluded.

The findings were published in Scientific Reports on February 2, 2023.


Health and Labour Sciences Research Grants [19FA1005, 20FA1005, 20EA1017]
Japan Society for the Promotion of Science (JSPS) KAKENHI Grants [20K10467, 20H00040, 21H04856]
National Institute for Environmental Studies; JST Grant [Grant No. JPMJPF2017]
Japan Health Research Promotion Bureau Research Fund [Grant No.2020-B-09]

Paper Information

Journal: Scientific Reports
Title: Association of combustible cigarettes and heated tobacco products use with SARS-CoV-2 infection and severe COVID-19 in Japan: a JASTIS 2022 cross-sectional study
DOI: 10.1038/s41598-023-28006-3
Author: Misako Nishimura, Kazuhisa Asai, Takahiro Tabuchi, Erika Toyokura, Takahiro Kawai, Atsushi Miyamoto, Tetsuya Watanabe, Tomoya Kawaguchi
Publish: Feb 2, 2023


Graduate School of Medicine
Kazuhisa Asai
E-mail: kazuasai[at]
*Please change [at] to @.


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