Background:
Heat-not-burn tobacco products are cigarettes heated by an electronic device to generate an aerosol containing nicotine. iQOS is the brand name of such a product by Philip Morris International. It was launched in December 2014 in Italy as a pilot country for the European market. Currently, no information is available on iQOS awareness, use and sales in Italy.

Methods:
We annually conduct a national-wide face-to-face survey on smoking. In order to investigate awareness and use of iQOS, we devoted to heat-not-burn tobacco product a specific section in our 2017 survey. The survey was conducted on a sample of 3086 individuals, who represented the Italian population aged ≥15 years (52.4 million). Official quarter sales data on iQOS were obtained from the Italian Ministry of Health and the relative web search volumes in Italy were retrieved from “Google trends”.

Results:
Among the investigated subjects, 19.5% were aware of iQOS, and 1.4% have tried it. Overall, 1.0% of never, 0.8% of ex- and 3.1% of current smokers have tried iQOS. As regard to e-cigarettes, 2.9% of ex- and 7.7% of current users have tried iQOS. In just one year, iQOS quarter sales were boosted by 17 times from 4.4 tonnes in the early 2016 to 80.0 tonnes in the early 2017, currently representing 0.4% of the whole tobacco market share; Google trends shows similar exponential increase in the relative web search volume.

Conclusions:
Although the share of iQOS in the whole tobacco market is still limited in Italy, we have observed a growing interest in it. Our individual-level data suggest that more than 700 thousand Italians have already tried this tobacco product, including more than 340 thousand never and 50 thousand ex-smokers. Attention should be paid on this emerging phenomenon, which may represent in the near future an impairing gateway to nicotine addiction.