A heated tobacco product (HTP) is a
tobacco
Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
product that heats the tobacco at a lower temperature than conventional
cigarette
A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opp ...
s.
These products contain
nicotine
Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
, which is a highly addictive chemical.
The heat generates an
aerosol
An aerosol is a suspension (chemistry), suspension of fine solid particles or liquid Drop (liquid), droplets in air or another gas. Aerosols can be natural or Human impact on the environment, anthropogenic. Examples of natural aerosols are fog o ...
or
smoke
Smoke is a suspension of airborne particulates and gases emitted when a material undergoes combustion or pyrolysis, together with the quantity of air that is entrained or otherwise mixed into the mass. It is commonly an unwanted by-product ...
to be inhaled from the tobacco, which contains nicotine and other chemicals.
HTPs may also contain additives not found in tobacco, including
flavoring chemicals.
HTPs generally heat tobacco to temperatures under 600 °C (1100 °F),
a lower temperature than conventional
cigarette
A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opp ...
s.
HTPs use embedded or external heat sources, heated sealed chambers, or product-specific customized cigarettes.
Whereas e-cigarettes are electronic devices that vaporize a liquid containing nicotine, HTPs usually use tobacco in leaf or some other solid form, although there are some hybrid products that can use both solid tobacco and
e-liquids
An electronic cigarette is a handheld battery (electricity), battery-powered Vaporizer (inhalation device), vaporizer that simulates tobacco smoking, smoking, but without tobacco combustion. E-cigarette components include a mouthpiece (drip tip) ...
. There are
various types of HTPs. The two most common designs are those that use an electric battery to heat tobacco leaf (e.g., IQOS, glo, Pax) and those that use a carbon ember that is lit and then heats the tobacco (e.g., Eclipse, REVO, TEEPS).
There are similar devices that heat
cannabis
''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: ''Cannabis sativa'', '' C. indica'', and '' C. ruderalis''. Alternatively ...
instead of tobacco.
A 2016
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
report did not find any evidence to support claims of
lowered risk or health benefits compared to conventional cigarettes. A 2018
Public Health England
Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a ...
report includes evidence that indicates HTPs may be safer than traditional cigarettes, but less safe than e-cigarettes. Some HTP aerosols studied were found to contain levels of nicotine and
carcinogen
A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...
s comparable to conventional cigarettes.
Although heated tobacco products may be less dangerous than cigarette smoking, the
UK Committee on Toxicity suggests that it would be better for smokers to
completely stop.
There is insufficient evidence on the effectiveness of HTPs on quitting smoking,
or possible effects of second-hand exposure.
The limited evidence on
air emissions from the use of HTPs indicates that toxic exposure from these products is greater than that of e-cigarettes. Smokers have reported HTP use to be less satisfying than smoking a cigarette.
As early as the 1960s, tobacco companies developed alternative tobacco products.
HTPs were introduced into the market in 1988, though they were not a commercial success.
The global decline in tobacco consumption may be one reason the industry has invented and marketed new products such as HTPs.
The latest generation of heated tobacco products may be an industry attempt to appeal with governments and health advocates by presenting a potential (but unproven) "harm reduction" product.
Current
smoking ban
Smoking bans, or smoke-free laws, are public policies, including criminal laws and occupational safety and health regulations, that prohibit tobacco smoking in certain spaces. The spaces most commonly affected by smoking bans are indoor work ...
s may or may not apply to heated tobacco products.
Health effects
![Heat-not-burn tobacco products being aerosolized by a testing machine](https://upload.wikimedia.org/wikipedia/commons/a/a7/Heat-not-burn_tobacco_products_being_aerosolized_by_a_testing_machine.jpg)
A 2016
Cochrane review
Cochrane (previously known as the Cochrane Collaboration) is a British international charitable organisation formed to organise medical research findings to facilitate evidence-based choices about health interventions involving health professi ...
found it unclear if the use of heated tobacco products (HTPs) would "substantially alter the risk of harm" over traditional cigarettes.
, it is impossible to quantify the health risk from using these products, as there is very limited information available on health effects.
It is unclear as to what the short- and long-term
adverse effect
An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complica ...
s are.
, a limited number of independent studies have been conducted on HTPs, and further research will likely increase understanding of health effects.
The different types of available HTPs vary in effect, creating a challenge for researchers. It is unknown how users evaluate product safety—one study found that about half of people believed they are safer than traditional cigarettes.
A 2016
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
report stated that claims of
lowered risk or health benefits for HTPs compared with traditional cigarettes were based on
industry-funded research
Industry funding of academic research in the United States is one of the two major sources of research funding in academia along with government support. Currently, private funding of research accounts for the majority of all research and developm ...
, and compelling independent research was unavailable to support these claims. It also noted evidence that HTPs may be as dangerous as traditional cigarettes.
Action on Smoking and Health
Action on Smoking and Health (ASH) is the name of a number of autonomous pressure groups (charities) in the anglosphere that seek to publicize the risks associated with tobacco smoking and campaign for greater restrictions on use and on cigar ...
in the UK stated in 2016 that due to "the tobacco industry's long record of deceit" regarding the health risks involving smoking, it is important to conduct independent studies into the health effects of tobacco products.
With an assorted range of
electronic cigarette
An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such ...
s devices available in the UK, it is unclear if HTPs offer any favorable benefit as a plausible harm reduction product. A 2018
Public Health England
Public Health England (PHE) was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. Its formation came as a ...
report states that HTPs may be much safer than traditional cigarettes but less safe than e-cigarettes. In a 2017 non-technical summary written by the
Committee on Toxicity
The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT) is a UK independent scientific committee that provides advice to the Food Standards Agency, the Department of Health and other Government Departments and A ...
, it recommends that smokers
completely stop, even though it found HTPs to be less harmful than smoking.
Emissions
Heated tobacco products expose the user and bystanders to an aerosol. The
aerosol
An aerosol is a suspension (chemistry), suspension of fine solid particles or liquid Drop (liquid), droplets in air or another gas. Aerosols can be natural or Human impact on the environment, anthropogenic. Examples of natural aerosols are fog o ...
contains levels of
nicotine
Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
,
volatile organic compound
Volatile organic compounds (VOCs) are organic compounds that have a high vapour pressure at room temperature. High vapor pressure correlates with a low boiling point, which relates to the number of the sample's molecules in the surrounding air, a ...
s, and
carcinogen
A carcinogen is any substance, radionuclide, or radiation that promotes carcinogenesis (the formation of cancer). This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes. Several radioactive substan ...
s comparable to regular cigarettes; they have also been found to contain more
acenaphthene
Acenaphthene is a polycyclic aromatic hydrocarbon (PAH) consisting of naphthalene with an ethylene bridge connecting positions 1 and 8. It is a colourless solid. Coal tar consists of about 0.3% of this compound.
Production and reactions
Acenaph ...
than regular cigarettes.
Other traditional cigarette emission substances such as
tar
Tar is a dark brown or black viscous liquid of hydrocarbons and free carbon, obtained from a wide variety of organic materials through destructive distillation. Tar can be produced from coal, wood, petroleum, or peat. "a dark brown or black bit ...
, nicotine,
carbonyl compounds
In organic chemistry, a carbonyl group is a functional group composed of a carbon atom double-bonded to an oxygen atom: C=O. It is common to several classes of organic compounds, as part of many larger functional groups. A compound containing a ...
(including
acetaldehyde
Acetaldehyde (IUPAC systematic name ethanal) is an organic chemical compound with the formula CH3 CHO, sometimes abbreviated by chemists as MeCHO (Me = methyl). It is a colorless liquid or gas, boiling near room temperature. It is one of the mos ...
,
acrolein
Acrolein (systematic name: propenal) is the simplest unsaturated aldehyde. It is a colorless liquid with a piercing, acrid smell. The smell of burnt fat (as when cooking oil is heated to its smoke point) is caused by glycerol in the burning fa ...
, and
formaldehyde
Formaldehyde ( , ) (systematic name methanal) is a naturally occurring organic compound with the formula and structure . The pure compound is a pungent, colourless gas that polymerises spontaneously into paraformaldehyde (refer to section F ...
), and
nitrosamines are also found in HTPs.
A 2017 study found a 10% rise in
carbon monoxide
Carbon monoxide (chemical formula CO) is a colorless, poisonous, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom connected by a triple bond. It is the simple ...
and formaldehyde air levels when HTPs were used indoors.
Another 2017 study discovered HTPs generated emissions of metal particulates, organic compounds, and
aldehyde
In organic chemistry, an aldehyde () is an organic compound containing a functional group with the structure . The functional group itself (without the "R" side chain) can be referred to as an aldehyde but can also be classified as a formyl grou ...
s, and suggests that HTPs generate less concentrations of airborne contaminants in indoor places in comparison to a traditional cigarette,
though their use still reduces indoor air quality.
A 2018 Public Health England report found that "
mpared with cigarettes, heated tobacco products are likely to expose users and bystanders to lower levels of particulate matter and harmful and potentially harmful compounds (HPHC). The extent of the reduction found varies between studies." It also noted that the evidence indicates that less nicotine was inhaled from HTPs than cigarette smoke, and exposure to
mutagen
In genetics, a mutagen is a physical or chemical agent that permanently changes nucleic acid, genetic material, usually DNA, in an organism and thus increases the frequency of mutations above the natural background level. As many mutations can ca ...
ic and other harmful substances is lower than with traditional cigarettes, though reduced exposure to harmful substances does not correlate with health risk severity.
Even low exposure can increase the risks for cancers, stroke, and other cardiovascular diseases compared to non-smokers.
Lower levels of harmful emissions have been shown, but lowering the risk to the smoker who transitions to using them has not been shown, as of 2018.
In 2017, the Committee on Toxicity found that HTPs do not reduce exposure or potential addiction to nicotine; some of the substances inhaled from using these products are carcinogens.
Physiological changes in response to heated tobacco emissions, such as multiple organ system inflammation, energy metabolism, and carcinogenesis, have not been well characterised due to limited research in this area, especially in animal models.
A 2018 ''
in vitro
''In vitro'' (meaning in glass, or ''in the glass'') studies are performed with microorganisms, cells, or biological molecules outside their normal biological context. Colloquially called "test-tube experiments", these studies in biology an ...
'' study suggested a less harmful pathophysiological response in human organotypic oral
epithelial
Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellula ...
cultures when exposed to such emissions.
A 2016 animal study showed that heated tobacco emissions did not increase
surfactant
Surfactants are chemical compounds that decrease the surface tension between two liquids, between a gas and a liquid, or interfacial tension between a liquid and a solid. Surfactants may act as detergents, wetting agents, emulsifiers, foaming ...
lipids and proteins, inflammatory
eicosanoid
Eicosanoids are signaling molecules made by the enzymatic or non-enzymatic oxidation of arachidonic acid or other polyunsaturated fatty acids (PUFAs) that are, similar to arachidonic acid, around 20 carbon units in length. Eicosanoids are a s ...
s and their metabolic enzymes, and several
ceramide
Ceramides are a family of waxy lipid molecules. A ceramide is composed of N-acetylsphingosine and a fatty acid. Ceramides are found in high concentrations within the cell membrane of eukaryotic cells, since they are component lipids that make up ...
classes in HTP-exposed mice when compared with their counterparts that were exposed to cigarette smoke. It also discovered that even with reduced
toxicant
A toxicant is any toxic substance, whether man-made or naturally occurring. By contrast, a toxin is a poison produced naturally by an organism (e.g. plant, animal, insect). The different types of toxicants can be found in the air, soil, water, or ...
s in HTP emissions, overuse (40 tobacco sticks per day) can still lead to
eosinophilic pneumonia
Eosinophilic pneumonia is a disease in which an eosinophil, a type of white blood cell, accumulates in the lungs. These cells cause disruption of the normal air spaces (alveoli) where oxygen is extracted from the atmosphere. Several different kin ...
in humans.
The impact on the overall population is unclear. Studies on second-hand HTP emissions as of 2018 were diverse and largely affiliated with manufacturers.
There is disagreement over the extent to which HTPs generate air emissions, and the emissions' composition. There is anticipated to be a reduced risk to bystanders where smokers were using heated tobacco products instead of smoking.
Limited evidence on air emissions suggests that toxic exposure from HTPs is greater than from e-cigarettes. There is no safe level of exposure to harm carcinogens, making it difficult to assess how much HTPs reduce health risks.
Addiction and quitting
HTPs contain the highly
addictive chemical
nicotine
Nicotine is a natural product, naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreational drug use, recreationally as a stimulant and anxiolytic. As ...
. The nicotine content between HTP and traditional cigarette emissions are in similar ranges, which suggests a similar addictiveness and dependence potential.
There is insufficient evidence on the efficacy of heated tobacco products on
quitting smoking
Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often make ...
.
A 2018 World Health Organization report states that "
nclusions cannot yet be drawn about their ability to assist with quitting smoking (cessation), their potential to attract new youth tobacco users (
gateway effect), or the interaction in dual use with other conventional tobacco products and e-cigarettes."
In 2017, the
Ministry of Health in New Zealand stated that "
ere is limited information on product use, including whether smokers are likely to switch completely from tobacco smoking or use both types of product, as well as initiation by non-smokers (including young people)." In 2017, the Committee on Toxicity stated "
e Committees were concerned over the potential for non-smokers including children and young people, who would not otherwise start to smoke cigarettes, to take up using these products as they are not without risk."
The availability of flavours in HTP products may appeal to non-smokers, and evidence suggests that individuals who have never used tobacco products, especially children and adolescents, could be susceptible to new products that could lead to the use of traditional cigarettes.
In 2017, the Committee on Toxicity noted that "
mmittees were particularly concerned for young people, who do not smoke, starting to use these products, due to the potential for longer exposure over the remainder of their lives compared to adults and to possible differences in sensitivity."
The dual use of HTPs and combustible products is common.
Trying an HTP was more frequent among adults below the age of 30 and regular traditional cigarette users.
A 2015 online survey found that 6.6% of 8240 respondents had tried an HTP at least once.
Research demonstrated that there is a high overlap between HTP users and female smokers.
According to four epidemiological papers, 10–45 per cent of non-smokers use these products, and show the effectiveness of the marketing of the
tobacco industry
The tobacco industry comprises those persons and companies who are engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products. It is a global industry; tobacco can grow in any ...
; for example, the HTP known as IQOS acts more as a gateway to traditional cigarette use (20% of users) than as a means of quitting (11% of users), and is not anticipated to have a lowered risk among dual users who make up the remaining 69%.
In 2016
Philip Morris International
Philip Morris International Inc. (PMI) is an American Multinational corporation, multinational tobacco company, with products sold in over 180 countries. The most recognized and best selling product of the company is Marlboro. Philip Morris I ...
(PMI) acknowledged that IQOS is probably as addictive as tobacco smoking.
IQOS is sold with a warning that states the best option is to avoid tobacco use altogether.
IQOS can record the user's smoking habits. While Philip Morris International stated it only retrieves the data when the product is not working properly, Gregory Connolly, a professor at
Northeastern University
Northeastern University (NU) is a private university, private research university with its main campus in Boston. Established in 1898, the university offers undergraduate and graduate programs on its main campus as well as satellite campuses in ...
who has studied IQOS, said that tobacco companies like PMI would have a "mega database" of Americans' smoking habits, and possibly "reprogram the current puffing delivery pattern of the IQOS to one that may be more reinforcing and with a higher addiction potential".
As of July 2017, not many US adults had tried using an HTP; approximately one in twenty US adults (including one in ten traditional cigarette users) have heard of HTPs.
In Italy, HTP use was 1.4% among the people and 3.1% among regular tobacco users.
A 2018 survey in Italy found that 45 per cent of people who experimented with the IQOS and 51 per cent who were interested in the product had never smoked before.
Therefore, such a product may represent, at least in Italy, a gateway for
nicotine addiction
Nicotine is a naturally produced alkaloid in the nightshade family of plants (most predominantly in tobacco and ''Duboisia hopwoodii'') and is widely used recreationally as a stimulant and anxiolytic. As a pharmaceutical drug, it is used for ...
among never-smokers rather than a
harm reduction
Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to de ...
substitution for current smokers.
In Germany, HTP use is not common and is generally more frequent among richer and educated smokers. Since its sale in Japan in 2014, HTP use has been high;
A 2017 survey in Japan found that of those who used the IQOS within the last month, 20 per cent had never smoked before. The products did not satisfy 86 per cent of users, and they did not quit using traditional cigarettes; they used both.
HTP use among youth is unknown, but monitoring is underway .
Nicotine yield
The limited data on HTP users show that they take short puffs and that the time between puffs is very short. Experimental tests show a higher volume of puffs at shorter intervals than with traditional cigarettes. A 2018 clinical trial found that tests of smokers switching to IQOS showed a tendency to take more puffs at shorter intervals.
Users experience blood nicotine levels that peak after six to seven minutes for both HTPs and traditional cigarettes. The IQOS produces slightly less blood nicotine overall than a traditional cigarette, but more than
nicotine gum
Nicotine gum is a type of chewing gum that delivers nicotine to the body. It is used as an aid in nicotine replacement therapy (NRT), a process for smoking cessation and quitting smokeless tobacco. The nicotine is delivered to the bloodstream via ...
. A 2016 study found that smokers were less satisfied and had a lower reduction in cravings with using an IQOS than with traditional cigarettes. In the study, smoking trial volunteers switching to an HTP, after an initial adjustment period, usually smoked more traditional cigarettes than those not switching, while reporting that they were less satisfying and rewarding than with regular cigarettes.
Sharper peaks in blood nicotine levels from inhalation cause greater nicotine dependence than oral consumption.
Nicotine replacement products
Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the ...
, for instance, deliver nicotine in a slow, stable manner, which is less addictive. Inhaled nicotine enters the blood quicker than oral consumption, and blood nicotine levels halve every one to two hours.
Nicotine withdrawal
Nicotine withdrawal is a group of symptoms that occur in the first few weeks after stopping or decreasing use of nicotine. Symptoms include intense cravings for nicotine, anger or irritability, anxiety, depression, impatience, trouble sleeping, ...
causes deteriorating mood and creates a craving for nicotine consumption.
Pregnancy
Pregnant women who wish to quit smoking but are unable to are left with few options.
As
nicotine replacement products
Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the ...
are often ineffective for quitting smoking, pregnant women turn to alternatives such as HTPs.
There is no information available on the potential impact of HTP emissions from mother to fetus .
The risk to the fetus from HTPs during pregnancy is hard to quantify ; although the risk to the fetus is probably less than traditional smoking during pregnancy, the Committee on Toxicity recommends that expectant mothers completely stop smoking.
Nicotine is harmful to the infant and the growing adolescent brain,
is metabolised much faster while a woman is pregnant, easily passes through the placental barrier, and collects in breast milk. There is also growing evidence that nicotine exposure during pregnancy is linked to
early birth,
stillbirth
Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can result in the feeling of guilt or grief in the mother. The term ...
, and abnormal brain growth.
Nicotine may result in
adverse effect
An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complica ...
s to the neurological growth of the fetus.
Nicotine can lead to
vasoconstriction
Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vessel ...
of uteroplacental vessels, which reduces the delivery of both nutrients and oxygen to the fetus. As a result, nutrition is re-distributed to prioritize vital organs, such as the heart and the brain, at the cost of less vital organs, such as the liver, kidneys, adrenal glands, and pancreas, which can lead to underdevelopment and functional disorders later in life. Animal research in regards to maternal nicotine exposure on rats showed a direct adverse impact on pancreas development by reducing endocrine
pancreatic islet
The pancreatic islets or islets of Langerhans are the regions of the pancreas that contain its endocrine (hormone-producing) cells, discovered in 1869 by German pathological anatomist Paul Langerhans. The pancreatic islets constitute 1–2% of ...
size and number, which was accompanied by a decrease in gene expression of specific transcription factors and blood glucose regulating hormones such as
insulin
Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism o ...
and
glucagon
Glucagon is a peptide hormone, produced by alpha cells of the pancreas. It raises concentration of glucose and fatty acids in the bloodstream, and is considered to be the main catabolic hormone of the body. It is also used as a Glucagon (medicati ...
. Affected rats exhibited significant pancreatic dysfunction and glucose intolerance. Other animal studies have reported insulin resistance in adult offspring due to maternal nicotine exposure; in animal models, nicotine has also been shown to activate
nicotinic acetylcholine receptor
Nicotinic acetylcholine receptors, or nAChRs, are receptor polypeptides that respond to the neurotransmitter acetylcholine. Nicotinic receptors also respond to drugs such as the agonist nicotine. They are found in the central and peripheral ne ...
s (nAChRs) in the brain, which regulate brain development. Nicotine exposure during the first trimester of pregnancy (2 mg/kg/d) leads to structural changes in the
hippocampus
The hippocampus (via Latin from Greek , 'seahorse') is a major component of the brain of humans and other vertebrates. Humans and other mammals have two hippocampi, one in each side of the brain. The hippocampus is part of the limbic system, a ...
and
somatosensory cortex
In physiology, the somatosensory system is the network of neural structures in the brain and body that produce the perception of touch (haptic perception), as well as temperature (thermoception), body position (proprioception), and pain. It is ...
in rats.
Construction
![Tobacco stick disassembled](https://upload.wikimedia.org/wikipedia/commons/8/86/Tobacco_stick_disassembled.png)
Nicotine is released from tobacco heated above 150 °C.
The burning process, substances emitted and their levels vary at different temperatures: distillation—the process during which nicotine and aromas are transferred from tobacco to smoke—occurs below 300 °C;
pyrolysis
The pyrolysis (or devolatilization) process is the thermal decomposition of materials at elevated temperatures, often in an inert atmosphere. It involves a change of chemical composition. The word is coined from the Greek-derived elements ''py ...
occurs around 300 °C–700 °C and involves the decomposition of biopolymers, proteins, and other organic materials and generates the majority of substances emitted in smoke; and
combustion
Combustion, or burning, is a high-temperature exothermic redox chemical reaction between a fuel (the reductant) and an oxidant, usually atmospheric oxygen, that produces oxidized, often gaseous products, in a mixture termed as smoke. Combusti ...
occurs above 750 °C and results in the generation of
carbon dioxide
Carbon dioxide (chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is transpar ...
,
carbon monoxide
Carbon monoxide (chemical formula CO) is a colorless, poisonous, odorless, tasteless, flammable gas that is slightly less dense than air. Carbon monoxide consists of one carbon atom and one oxygen atom connected by a triple bond. It is the simple ...
, and water.
The temperature the tobacco reaches greatly varies among HTPs; it depends on the process used to heat the tobacco.
For example, HeatSticks are heated to a maximum of 350 °C, a temperature sufficient to enable pyrolytic decomposition of some organic materials,
while the glo iFuse heats tobacco to around 35 °C.
The formation of toxic volatile organic compounds, including formaldehyde, acetaldehyde, and acrolein, have been reported in e-cigarette aerosols at similar temperatures as the IQOS; flavoring chemicals in e-cigarettes have been discovered to undergo
thermal degradation
Thermal decomposition, or thermolysis, is a chemical decomposition caused by heat. The decomposition temperature of a substance is the temperature at which the substance chemically decomposes. The reaction is usually endothermic as heat is req ...
and contribute significantly to levels of toxic aldehydes emitted in e-cigarette aerosols,
as demonstrated by the presence of carbon monoxide (CO), nitrogen oxides, soot or tars, and aldehydes in emissions.
Gases, liquid, and solid particles are also found in the emissions; the solids in the emissions have been called nicotine-free dry particulate matter rather than tar in papers written by people connected to the tobacco industry.
Since the constituents of HeatSticks may differ from combustible cigarettes, including flavourants and additives, it is plausible that the IQOS aerosol may contain substances not found in tobacco smoke.
The emissions of the IQOS HeatSticks and the IQOS menthol mini-cigarettes contain about three times the amount of water and about half the amount of
tar
Tar is a dark brown or black viscous liquid of hydrocarbons and free carbon, obtained from a wide variety of organic materials through destructive distillation. Tar can be produced from coal, wood, petroleum, or peat. "a dark brown or black bit ...
found in traditional cigarette emissions.
The IQOS HeatSticks do not generate a flame, but are
charred Charring is a chemical process of incomplete combustion of certain solids when subjected to high heat. Heat distillation removes water vapour and volatile organic compounds ( syngas) from the matrix. The residual black carbon material is char, as d ...
after use.
Until 2016,
Phillip Morris International researchers stated their IQOS product produces smoke.
The HTP consists of three components with different functions: the processed tobacco stick; a pen-like heater (holder) that the tobacco stick is inserted, which is then heated by an electrically controlled heating element; and a charger that recharges the heater after use.
The heated tobacco products automatically stops the heating process after six minutes or 14 moves so that pyrolytic products and pollutant release are limited in time as well as by a maximum number of puffs per stick.
HTPs may not generate side-stream smoke because they do not fully combust, but the temperatures reached are sufficient for pyrolysis to happen.
There are devices that use a reaction that resembles pyrolysis or combustion, but research has not determined which of the two it is.
The tobacco stick contains a compressed tobacco film made of a dried tobacco suspension that has been rolled up into a paper-thin brown tobacco foil and several filter elements.
This film consists of about 70% tobacco, as well as humectants (such as water and
glycerin
Glycerol (), also called glycerine in British English and glycerin in American English, is a simple triol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in lipids known ...
, to prevent the tobacco from drying out and promote aerosol formation), binders, and flavorings. The filter elements consist of two independent systems: a polymer film filter that cools the aerosol, and a soft cellulose acetate mouthpiece filter that mimics the sensory aspects of a traditional cigarette.
HTPs are
battery
Battery most often refers to:
* Electric battery, a device that provides electrical power
* Battery (crime), a crime involving unlawful physical contact
Battery may also refer to:
Energy source
*Automotive battery, a device to provide power t ...
-powered systems that produce nicotine-containing emissions by heating tobacco.
For this purpose, tobacco sticks are placed in a corresponding heater and heated to about 250–350 °C (around 500 °F),
which result in nicotine-containing emissions that are inhaled via a mouthpiece with a filter segment.
HTPs are hybrids between electronic and conventional cigarettes: they are equipped with a device that heats the product without reaching combustion to generate aerosol, while using "real" tobacco instead of nicotine-containing liquids.
There are products that have a time limit so that the user is forced to inhale the nicotine within 3.5–10 minutes prior to the device turning off.
This function helps support blood nicotine peaks that result in an increased
nicotine dependence
Nicotine dependence is a state of dependence upon nicotine. Nicotine dependence is a chronic, relapsing disease defined as a compulsive craving to use the drug, despite social consequences, loss of control over drug intake, and emergence of wit ...
.
There are three general types of heated tobacco products.
One that immediately heats processed tobacco to generate aerosol, another that uses processed tobacco that is heated in (but not generate) an aerosol, and one where the processed tobacco gives flavour to the aerosol as the latter moves over the former.
HTPs heat tobacco leaves at a lower temperature than traditional cigarettes.
Another type of HTP is the loose-leaf tobacco
vaporizer
Vaporizer or vaporiser may refer to:
*Anesthetic vaporizer, a device used in the administration of anesthesia
* Electronic cigarette, or a part of one (often called a "PV" or "personal vaporizer")
*Humidifier, a household appliance that increases ...
that involves putting loose-leaf tobacco into a chamber that is electrically heated with an element.
History
As early as the 1960s, the tobacco companies developed alternative tobacco products to supplement the cigarette market.
The first commercial HTP was the
Premier
Premier is a title for the head of government in central governments, state governments and local governments of some countries. A second in command to a premier is designated as a deputy premier.
A premier will normally be a head of governm ...
by
R. J. Reynolds
Richard Joshua Reynolds (July 20, 1850 – July 29, 1918) was an American businessman and founder of the R. J. Reynolds Tobacco Company.
The son of a tobacco farmer, he worked for his father and attended Emory & Henry College from 1868 to 1870 ...
,
a smokeless cigarette launched in 1988 and described as difficult to use.
Many smokers disliked the taste, and it was not popular with users when it was
test-marketed in Arizona and Missouri. It was shaped like a traditional cigarette, and required combustion to move the smoldered
charcoal
Charcoal is a lightweight black carbon residue produced by strongly heating wood (or other animal and plant materials) in minimal oxygen to remove all water and volatile constituents. In the traditional version of this pyrolysis process, cal ...
past processed
tobacco
Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
containing more than 50 percent
glycerin
Glycerol (), also called glycerine in British English and glycerin in American English, is a simple triol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in lipids known ...
to create an
aerosol
An aerosol is a suspension (chemistry), suspension of fine solid particles or liquid Drop (liquid), droplets in air or another gas. Aerosols can be natural or Human impact on the environment, anthropogenic. Examples of natural aerosols are fog o ...
.
In 1989,
after spending $325 million,
R. J. Reynolds pulled the Premier from the market after the
American Medical Association
The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016.
The AMA's state ...
and other organizations recommended that the US
Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) restrict it or classify it as a drug.
The Premier product concept was developed further and re-launched as the
Eclipse
An eclipse is an astronomical event that occurs when an astronomical object or spacecraft is temporarily obscured, by passing into the shadow of another body or by having another body pass between it and the viewer. This alignment of three ce ...
in the mid-1990s,
which was available in limited distribution ,
and promoted via
viral marketing
Viral marketing is a business strategy that uses existing social networks to promote a product mainly on various social media platforms. Its name refers to how consumers spread information about a product with other people, much in the same way tha ...
.
Reynolds American
Reynolds American, Inc. is an American tobacco company which is a subsidiary of British American Tobacco and is the second-largest tobacco company in the United States. Its holdings include R. J. Reynolds Tobacco Company, American Snuff Company ...
also introduced a brand called Revo and stated that it was a "repositioning" of the Eclipse.
The Revo was withdrawn in 2015.
The Steam Hot One was sold in Japan by
Japan Tobacco
Hepburn: ''Nippon Senbai Kōsha''
, type = 1985-: Public (''kabushiki gaisha'') 1949-1985: Statutory corporation
, traded_as =
, industry = FoodTobacco
, foundation = 1898 (as Imperial Japanese Tobacco Company)1 June 1949 (as Japan Tobacco ...
.
In October 1998, Philip Morris launched the Accord in the US. It was a specialised cigarette was designed to be used with the electric heating system. Advertisements stating reduced risk were drafted for the Accord in the US, but were never released.
In 1998, the company launched the Accord in Osaka, Japan, and renamed it Oasis. The battery-powered,
pager
A pager (also known as a beeper or bleeper) is a wireless telecommunications device that receives and displays alphanumeric or voice messages. One-way pagers can only receive messages, while response pagers and two-way pagers can also acknow ...
-size product was marketed as "low-smoke".
An attempt was made in 2007 by Kenneth Podraza, the Vice President of Research and Development at Philip Morris in the US at the time, to get the
Surgeon General of the United States
The surgeon general of the United States is the operational head of the United States Public Health Service Commissioned Corps (PHSCC) and thus the leading spokesperson on matters of public health in the federal government of the United States. Th ...
to endorse it.
The Surgeon General did not reply to Podraza's letter.
Few people used the Accord, and most of them also continued to use traditional cigarettes.
The Accord ceased production in 2006.
In 2007
Philip Morris International
Philip Morris International Inc. (PMI) is an American Multinational corporation, multinational tobacco company, with products sold in over 180 countries. The most recognized and best selling product of the company is Marlboro. Philip Morris I ...
launched the Heatbar, which was very similar to the Accord.
It was around the size of a
mobile phone
A mobile phone, cellular phone, cell phone, cellphone, handphone, hand phone or pocket phone, sometimes shortened to simply mobile, cell, or just phone, is a portable telephone that can make and receive calls over a radio frequency link whil ...
and was said to heat specially-designed cigarettes rather than
burning
Combustion, or burning, is a high-temperature exothermic redox chemical reaction between a fuel (the reductant) and an oxidant, usually atmospheric oxygen, that produces oxidized, often gaseous products, in a mixture termed as smoke. Combusti ...
them.
The Heatbar did not obtain any significant user reception, and was discontinued after the only benefit found was to lower
second-hand smoke
Passive smoking is the inhalation of tobacco smoke, called secondhand smoke (SHS), or environmental tobacco smoke (ETS), by persons other than the intended "active" smoker. It occurs when tobacco smoke enters an environment, causing its inhalat ...
. The Accord and Heatbar are predecessors of Philip Morris International's current HTPs.
HTPs were not a commercial success, and most of them were quickly taken off the market following their debut.
In years leading up to 2018, increased
tobacco control
Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use ...
measures have directed the
tobacco industry
The tobacco industry comprises those persons and companies who are engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products. It is a global industry; tobacco can grow in any ...
to develop alternative tobacco products, such as HTPs.
There has been a global decline in tobacco consumption that, if continued, will negatively impact the tobacco industry's profits, which has forced the industry to invent and market new products like HTPs.
The introduction of HTPs may also have been a response to the growing popularity of
e-cigarettes
An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such ...
beginning around 2007 after independent companies introduced them before major multinational tobacco companies entered the e-cigarettes market.
Furthermore, the global decline of cigarette consumption and decrease in adult smoking prevalence (from 24% in 2007 to 21% in 2015), combined with the success of tobacco control, including the implementation of the
WHO Framework Convention on Tobacco Control
The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is a treaty adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003. It became the first World Health Organization treaty adopted under ...
, may also have led the tobacco companies to consider alternative products to protect their profits and political interests.
T.L. Caputi suggests that the ubiquity of e-cigarettes and the growing dissatisfaction with not providing a "throat-hit" may present an opportunity for HTPs.
Philip Morris International anticipates a future without traditional cigarettes, but campaigners and industry analysts question the probability of traditional cigarettes being overshadowed by either e-cigarettes or other products like the IQOS.
Products
![Heat-not-burn tobacco system](https://upload.wikimedia.org/wikipedia/commons/a/a0/Heat-not-burn_tobacco_system.png)
HTPs use a heating system where the tobacco is heated and
aerosolised.
In addition to nicotine, they contain additives that are flavoured and derived from substances other than tobacco.
Evidence shows that the concentrations of nicotine in mainstream HTP aerosols are lower than in cigarette smoke. Smokers regularly reported HTP use to be less satisfying than smoking a cigarette. Tested HTPs provided more nicotine in the aerosol than a
cigalike e-cigarette but not as much nicotine compared with a tank-style e-cigarette.
HTPs are designed to be similar to their combustible counterparts by replicating the oral inhalation and exhalation, taste, rapid systemic delivery of nicotine, hand-to-mouth feel and throat hit sensations (depending on the temperature) when smoking traditional cigarettes.
HTPs aim for a niche between combustible tobacco smoking and e-cigarettes that aerosolise nicotine.
There are different types of HTPs in the marketplace:
some use tobacco sticks like glo and IQOS, while others use loose-leaf tobacco such as Pax and Ploom.
Firefly vaporizers
The Firefly developed the Firefly 2, which heats loose-leaf plant material and concentrates and is often used to aerosolise
cannabis
''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: ''Cannabis sativa'', '' C. indica'', and '' C. ruderalis''. Alternatively ...
,
and is more compact than the original Firefly vaporizer.
It uses a patented heating technology that heats the device up to the desired temperature (between 200 and 500 °F) with each puff rather than a preset temperature setting from the beginning.
glo
In 2016,
British American Tobacco
British American Tobacco plc (BAT) is a British multinational company that manufactures and sells cigarettes, tobacco and other nicotine products. The company, established in 1902, is headquartered in London, England. As of 2019, it is the large ...
launched a battery-powered heated product called glo in Japan before selling it in South Korea,
Switzerland, Russia,
and Ukraine.
In France, glo uses tobacco sticks called Neostiks.
It uses a
heating element
A heating element converts electrical energy into heat through the process of Joule heating. Electric current through the element encounters resistance, resulting in heating of the element. Unlike the Peltier effect, this process is independe ...
with a tobacco stick that heats up to 240 °C.
glo produces approximately 50% less nicotine emissions than IQOS.
In May 2017 British American Tobacco released i-glo in Canada.
Bonnie Herzog, a senior analyst at
Wells Fargo Securities
Wells Fargo & Company is an American multinational financial services company with corporate headquarters in San Francisco, California; operational headquarters in Manhattan; and managerial offices throughout the United States and intern ...
, stated that the proposed acquisition of
R. J. Reynolds
Richard Joshua Reynolds (July 20, 1850 – July 29, 1918) was an American businessman and founder of the R. J. Reynolds Tobacco Company.
The son of a tobacco farmer, he worked for his father and attended Emory & Henry College from 1868 to 1870 ...
by British American Tobacco in 2016 would let them catch up with the competition. glo is marketed as being easier to operate than IQOS.
The glo iFuse debuted in Romania in 2015,
and is a hybrid of a heated tobacco product and an e-cigarette.
It consists of a heating element, a liquid tank (like e-cigarettes), and a tobacco cavity through which the aerosol passes and is infused with tobacco flavour.
It uses cartridges called Neopods, and heats tobacco to approximately 35 °C.
IQOS
IQOS ( ) is a non-combustible reduced risk smoking alternative that was introduced in June 2014 and is marketed by
Philip Morris International
Philip Morris International Inc. (PMI) is an American Multinational corporation, multinational tobacco company, with products sold in over 180 countries. The most recognized and best selling product of the company is Marlboro. Philip Morris I ...
(PMI) under the
Marlboro
Marlboro (, ) is an American brand of cigarettes, currently owned and manufactured by Philip Morris USA (a branch of Altria) within the United States and by Philip Morris International (now separate from Altria) outside the US. The largest Mar ...
and
Parliament
In modern politics, and history, a parliament is a legislative body of government. Generally, a modern parliament has three functions: Representation (politics), representing the Election#Suffrage, electorate, making laws, and overseeing ...
brands.
Although it is marketed as a novel product, it is very similar to the Accord released by the same company in 1998; however, the IQOS sticks have more nicotine, more tar, and less tobacco.
They are heated at a lower temperature.
Initially launched in 2014 in
Nagoya
is the largest city in the Chūbu region, the fourth-most populous city and third most populous urban area in Japan, with a population of 2.3million in 2020. Located on the Pacific coast in central Honshu, it is the capital and the most pop ...
, Japan, and
Milan
Milan ( , , Lombard: ; it, Milano ) is a city in northern Italy, capital of Lombardy, and the second-most populous city proper in Italy after Rome. The city proper has a population of about 1.4 million, while its metropolitan city h ...
, Italy
IQOSis being introduced to other countries; , it is available in 49 countries.
PMI has projected that when 30 billions units are sold, the IQOS would increase profits by $700 million.
In October 2018, PMI introduced a less expensive version of IQOS called IQOS 3 in Tokyo, Japan.
The IQOS 3 Multi was also launched, and is capable of multiple consecutive uses.
The IQOS consists of a charger around the size of a mobile phone and a pen-like holder.
The disposable tobacco stick, also known as a HeatStick,
is described as a mini-cigarette.
The sticks contain processed tobacco soaked in
propylene glycol
Propylene glycol (IUPAC nomenclature, IUPAC name: propane-1,2-diol) is a viscous, colorless liquid, which is nearly odorless but possesses a faintly sweet taste. Its chemical formula is CH3CH(OH)CH2OH.
Containing two Alcohol (chemistry), alcoho ...
.
The stick is inserted into the holder which then heats it to temperatures up to 350 °C,
and the amount of nicotine provided may be a little strong for light cigarette smokers.
Users have reported less smell and odor on clothing.
There is a limited amount of research on the effect of IQOS on the user's health.
The physical effects on users are not yet known.
The emissions of IQOS are considered to be smoke by independent researchers, and were called smoke by Phillip Morris researchers until 2016.
The emissions generated by IQOS contain the identical
harmful constituents as tobacco cigarette smoke, including volatile organic compounds at comparable levels to cigarette smoke, polycyclic aromatic hydrocarbons, and carbon monoxide.
Each of these substances, on the basis of rigorous research of cigarette smoke, are known to result in significant harms to health.
According to
, IQOS is "harmful to health, but probably less harmful than smoking tobacco cigarettes".
In 2016, PMI submitted a multi-million page application to the US FDA for IQOS to be authorized as a
modified risk tobacco product.
In March 2017, PMI submitted a premarket tobacco product application regarding its IQOS product to the US FDA.
In December 2017,
Reuters
Reuters ( ) is a news agency owned by Thomson Reuters Corporation. It employs around 2,500 journalists and 600 photojournalists in about 200 locations worldwide. Reuters is one of the largest news agencies in the world.
The agency was estab ...
published documents and testimonies of former employees detailing irregularities in the
clinical trial
Clinical trials are prospective biomedical or behavioral research studies on human participants designed to answer specific questions about biomedical or behavioral interventions, including new treatments (such as novel vaccines, drugs, dietar ...
s conducted by PMI for the approval of the IQOS product by the US FDA.
The advisory panel appointed by the US FDA reviewed Philip Morris International's application in January 2018.
The FDA granted permission to PMI to sell IQOS in the US on 30 April 2019, which also requires the company to follow strict marketing restrictions.
IQOS formally launched in the US in October 2019.
On 7 July 2020, the US FDA announced its ruling 456, which granted an "exposure modification" order that allows PMI to market IQOS in the United States.
iSmoke OneHitter
The iSmoke OneHitter by iSmoke can be used as a loose-leaf tobacco vaporizer or for use with waxy oils.
It is described as a "heat, not burn" tobacco vaporizer,
and was launched in 2015. It has a chamber that can be filled with up to 800 milligrams of tobacco.
IUOC 2
The 2 is marketed by Shenzhen Yukan Technology Co., Limited, of China.
The HTP can use any pack of 20 cigarettes on a single battery charge and does not use tobacco-filled cartridges.
It is an updated version over the original IUOC and was formally launched in 2018 at
InterTabac in Germany.
lil
The lil is an HTP that heats a cigarette stick with a circular blade that was launched by the
Korea Tobacco & Ginseng Corporation
KT&G Corporation (), originally Korea Tobacco & Ginseng, is the leading tobacco company in South Korea with annual sales over US$4 billion. KT&G was originally a government-owned monopoly but was privatized and today is publicly traded, competing ...
on 20 November 2017.
According to the company, a two-hour battery charge lasts for up to 20 cigarette sticks, its refills are cheaper than the IQOS and glo, and will fit in the IQOS product, though they do not recommend doing so for safety reasons.
Mok
In May 2019,
China Tobacco
The State Tobacco Monopoly Administration () or China National Tobacco Corporation ( commonly known as China Tobacco, CNTC) () is a Chinese government agency responsible for tobacco regulation and a state-owned manufacturer of tobacco products, ...
debuted the Mok in Korea.
According to the company, Mok is more compact and weighs less than other products such as glo, IQOS, and lil.
The Coo sticks are longer and wider than tobacco sticks from other companies.
Pax vaporizers
In 2010, the company Ploom (later rebranded as
Pax Labs
Pax Labs (formerly Ploom and stylized as PAX Labs) is an American electronic vaporizer company founded in 2007 that markets the Pax vaporizers. The company developed the Juul (pronounced jewel) e-cigarette; Juul Labs was spun out as a separate ...
) launched a butane-powered product used to heat tobacco or botanical products. Later models replaced the butane heating with an electric system. The Pax 2 vaporizer uses loose plant material such as tobacco or cannabis and remains cool to the touch while the oven heats to one of four temperatures (up to 455 °F).
The Pax 3 takes 15 seconds to heat up and can be used to heat cannabis flowers.
Ploom vaporizers
In January 2016,
Japan Tobacco
Hepburn: ''Nippon Senbai Kōsha''
, type = 1985-: Public (''kabushiki gaisha'') 1949-1985: Statutory corporation
, traded_as =
, industry = FoodTobacco
, foundation = 1898 (as Imperial Japanese Tobacco Company)1 June 1949 (as Japan Tobacco ...
released Ploom,
which has been withdrawn from the US.
The brand remained with Japan Tobacco and the product has been replaced with Ploom Tech, where an aerosol passes through a capsule of granulated tobacco leaves.
The Ploom brand uses aluminum capsules called Vapodes, where tobacco can heat up to 180 °C.
Because the Ploom Tech heats up more, it may generate more harmful emissions.
In January 2019, Japan Tobacco introduced Ploom TECH+ and Ploom S in Tokyo, Japan.
Sales expanded throughout Japan in 2017. Japan Tobacco intended to spend $500 million to increase their heated tobacco manufacturing capacity by late 2018.
Studies have not been conducted on
Japan Tobacco International
JTI - Japan Tobacco International is the international tobacco division of Japan Tobacco, a leading international tobacco product manufacturer. The holding company is JT International SA and headquartered in Geneva, Switzerland, and sells its b ...
's Ploom product .
Pulze
In 2018,
Imperial Brands
Imperial Brands plc (formerly Imperial Tobacco Group plc), is a British multinational tobacco company headquartered in Bristol, England. It is the world's fourth-largest international cigarette company measured by market share after Philip Mo ...
was developing a heated tobacco product named Pulze.
TEEPS
In December 2017, PMI launched TEEPS in the Dominican Republic.
It is an HTP that looks similar to a traditional cigarette.
Instead of an electrically controlled heating system, it uses a carbon heat source that, once lit, passes heat to a processed tobacco plug.
Cigoo
In September 2020, Yunnan Xike Science & Technology Co., Ltd. launched Cigoo;
according to the company, it is a heated herbal product which releases nicotine and aroma aerosol at 300 °C, similar to mainstream HTPs.
Instead of using reconstituted tobacco film in the stick,
Cigoo sticks use patented plant particle as a carrier, added flavourants and additives.
TEO
The TEO heats a
cigarette stick with a heating blade, and was launched by Shenzhen ESON Technology Co. Ltd. ("ESON") in Dec. 2021 after PODA. NEAFS tobacco-free sticks does not use tobacco, but instead a nicotine infused, tea-based organic compound.
Comparison to mainstream smoke of traditional cigarettes
Contents of selected
analyte
An analyte, component (in clinical chemistry), or chemical species is a substance or chemical constituent that is of interest in an analytical procedure. The purest substances are referred to as analytes, such as 24 karat gold, NaCl, water, etc. ...
s in the mainstream aerosol of a heated tobacco product compared to the mainstream smoke of traditional cigarettes.
The highest and lowest values in two different types of tobacco sticks and traditional cigarettes were given by Mallock ''et al.'' and Counts ''et al.'' respectively.
Column 5 shows the reduction of the analytes in the mainstream aerosol of the heated tobacco product compared to traditional cigarettes by percentage.
Tobacco stick, d. h. for heated tobacco products: a tobacco stick; for traditional cigarette: a cigarette.
All values were generated using the Health Canada Intense (HCI) puffing conditions.
''TPM'' = total
particulate matter, and ''NFDPM'' = nicotine-free dried particulate matter.
Prevalence
![11 - Cigarette and HTP Sales in Japan](https://upload.wikimedia.org/wikipedia/commons/e/eb/11_-_Cigarette_and_HTP_Sales_in_Japan.png)
]
, HTPs are being introduced in markets around the world,
and since October 2019, they have been sold in at least 49 countries.
They are not as globally popular as the
electronic cigarette, e-cigarette, which has an estimated global user count of 20 million.
, the IQOS is the most popular product,
and was authorised for marketing by the FDA in the US on 30 April 2019.
, the industry has been rapidly introducing new heated tobacco products.
HTPs were first sold in Japan,
and several brands have been marketed there since 2014.
Since the introduction of HTP in Japan there has been a 32% drop in the sale of tobacco cigarettes.
The share of the market in South Korea for heated tobacco products has surged at least five-fold during the last two years leading up to 2019.
As of early 2018, these products are not sold in France.
Tobacco industry
The tobacco industry comprises those persons and companies who are engaged in the growth, preparation for sale, shipment, advertisement, and distribution of tobacco and tobacco-related products. It is a global industry; tobacco can grow in any ...
leaders predicted that HTPs may displace traditional cigarette smoking and, by extension,
tobacco control
Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use ...
strategies typically framed around cigarettes.
Since the introduction of PMI's IQOS brand in select Japanese cities in November 2014,
web search
Web most often refers to:
* Spider web, a silken structure created by the animal
* World Wide Web or the Web, an Internet-based hypertext system
Web, WEB, or the Web may also refer to:
Computing
* WEB, a literate programming system created by ...
es in Japan for "heat-not-burn products" (a marketing name for HTPs) increased substantially; average monthly searches rose 1,426% (
95% CI
In frequentist statistics, a confidence interval (CI) is a range of estimates for an unknown parameter. A confidence interval is computed at a designated ''confidence level''; the 95% confidence level is most common, but other levels, such as 9 ...
: 746–3,574) during 2015–2016, and they continued to grow an additional 100% (95% CI: 60–173) between 2016 and 2017; in practical terms, there are now between 5.9 and 7.5 million heat-not-burn related
Google searches in Japan each month based on the latest search estimates for September 2017. Moreover, forecasts relying on the historical trend suggest heat-not-burn searches would increase an additional 32% (95%CI: -4 to 79) during 2018, compared to current estimates for 2017 (January–September), with further growth expected.
Queries for heat-not-burn in Japan occur more frequently than queries for e-cigarettes in the United States, with the Japanese heat-not-burn queries first eclipsing e-cigarette queries in April 2016.
Further, the change in average monthly queries for heat-not-burn in Japan between 2015 and 2017 was 399 (95% CI: 184–1,490) times larger than the change in average monthly queries for e-cigarettes in the United States over the same time period, increasing by 2,956% (95% CI: 1,729–7,304) compared to only 7% (95% CI: 3–13), which indicate that interest in heat-not-burn may outpace interest in e-cigarettes in the future.
File:Google searches for heat-not-burn tobacco outpace past rise of electronic cigarettes.jpg, alt=Google searches for heat-not-burn tobacco (heated tobacco) outpace rise of electronic cigarettes. The above figure shows the Relative Search Volume (scaled from 0–100 and adjusted for number of total Google search volumes per month in Japan and the USA) for heat-not-burn and e-cigarette products., Google searches for heat-not-burn tobacco (heated tobacco) outpace rise of electronic cigarette
An electronic cigarette is an electronic device that simulates tobacco smoking. It consists of an atomizer, a power source such as a battery, and a container such as a cartridge or tank. Instead of smoke, the user inhales vapor. As such ...
s. The above figure shows the Relative Search Volume (scaled from 0–100 and adjusted for number of total Google search volumes per month in Japan and the USA) for heat-not-burn and e-cigarette products.
HTP demand presents a host of tobacco control challenges similar to e-cigarettes and new challenges specific to these products. They have been advertised as reduced-risk tobacco products in their Japanese test market.
Marketing
The term "heat-not-burn" refers to tobacco heated (at ~350 °C) by an electrically powered element or carbon instead of being fully combusted (at ~800 °C).
Terms used in marketing for cigarette-like products that "heat rather than burn" refer to them as "reduced risk" and "innovative".
Marketing slogans like "heat-not-burn" cannot be a substitute for science.
The tobacco industry has described them as "not-burned" (heat-not-burn), though it has backtracked from this claim .
HTPs are not typically marketed as a harmless substitute to smoking,
though they have been marketed as a "smoke-free" alternative to traditional cigarettes, and promoted as a way to lower risk from smoking.
The IQOS product has been advertised as emitting "no smoke".
This advertisement claim is not a replacement for science.
It is expected that the promotion associated with these products will worsen the worldwide tobacco risk.
Companies employ similar strategies previously used for traditional cigarettes, such as marketing through a variety of outlets, including
celebrity endorsements.
"The tobacco industry has opened heated tobacco product flagship stores, cafes and sponsored public events such as concerts and car races around the world, which is alarming," said
Judith Mackay, director of the Asian Consultancy on Tobacco Control.
Internal documents and statements by PMI researchers have contradicted PMI's claims about reduced harm in regard to the IQOS product.
For example, in 2018, four PMI researchers who worked for the company stated that the lowered levels of certain substances produced by the IQOS did not automatically translate into the product being safer, even though PMI stated that the IQOS is safer than traditional cigarettes, as 58 substances in IQOS aerosols were found at lower levels than in cigarette smoke.
The tobacco industry claims that smokers will switch to HTPs; however, IQOS users are more likely to smoke and/or use e-cigarettes as well. Among those who have tried or intend to try IQOS, never-smokers equal or outnumber smokers. A review of PMI's research found that smokers did not understand "switching completely" and that IQOS users are not likely to switch completely.
Since 2017, PMI has been promoting its IQOS product in Europe and Asia,
where IQOS products are sold as an alternative to regular cigarettes.
Outside of an IQOS retail shop in Canada, marketing included a display sign with the message, "Building a Smoke-Free Future".
Philip Morris International intends to convert its customers in Japan to using heated tobacco products.
There has been significant controversy surrounding the marketing and use of these products.
The tobacco companies are using a series of claims in the marketing of HTPs.
In both websites and statements to the media and investors, HTPs are presented as less harmful but not risk-free. In a few instances, marketing materials claim that heated tobacco products are potentially helpful to smokers who want to quit. Some media accounts that announced product launches state that HTPs reduce the levels of harmful tobacco components by 90–95% compared to traditional cigarettes, while others emphasise the lack of odor or visible emissions as part of marketing campaigns; , there is no evidence to confirm the former claim.
However, the public can perceive "lower exposure" claims as lower risk, even if no such claim was made explicitly.
Other marketing claims highlight that these products produce no smoke (i.e., "smoke-free").
Implied in these claims, in advertisements and stores globally, is that smokers should switch from traditional cigarettes to these new, allegedly less harmful, products.
The tobacco industry's use of the "harm reduction" framework also serves to fracture the
tobacco control
Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use ...
movement, leaving it without a unified voice to communicate with the public, the media and with policy makers on the strategies to advance tobacco control.
The concept of harm reduction has traditionally been embraced in several public health fields such as clean needles for injectable drug use and has been explored by some tobacco control experts in the past, with enthusiasm for the possibility of harm reduction growing with the widespread availability of e-cigarettes in certain markets.
The tobacco industry frames harm reduction as a common ground with health advocates and a possible entry point to influence legislation and regulation of tobacco products.
The tobacco companies use heated tobacco products as part of their broader political and public relations activities to position them as 'partners' to address the tobacco epidemic rather than as the vectors that are causing it.
This is a similar strategy previously used by the tobacco industry to promote itself as a partner of public health in reducing the harms of tobacco, while obfuscating the
scientific evidence
Scientific evidence is evidence that serves to either support or counter a scientific theory or hypothesis, although scientists also use evidence in other ways, such as when applying theories to practical problems. "Discussions about empirical ev ...
pointing that harm reduction is achieved through tobacco control policies that decrease consumption.
Regulation
HTPs are subject to different regulations than traditional cigarettes. For example, some
smoking ban
Smoking bans, or smoke-free laws, are public policies, including criminal laws and occupational safety and health regulations, that prohibit tobacco smoking in certain spaces. The spaces most commonly affected by smoking bans are indoor work ...
s do not extend to include them,
and in the majority of the countries in which they have been sold, they have been taxed at a lower rate than traditional cigarettes.
Tobacco companies have used these products to seek exemptions and relaxations of existing tobacco control policies,
and have used them in attempts to influence regulatory policy to sustain and increase their clientele in the midst of decreasing cigarette usage.
In the United States, these products fall under the jurisdiction of the
Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) as amended by the
Family Smoking Prevention and Tobacco Control Act
Family (from la, familia) is a group of people related either by consanguinity (by recognized birth) or affinity (by marriage or other relationship). The purpose of the family is to maintain the well-being of its members and of society. Ideall ...
of 2016.
In the same year,
Action on Smoking and Health
Action on Smoking and Health (ASH) is the name of a number of autonomous pressure groups (charities) in the anglosphere that seek to publicize the risks associated with tobacco smoking and campaign for greater restrictions on use and on cigar ...
stated in 2016 that "unless and until independent evidence shows that IQOS and similar products are substantially less harmful than smoking then these products should be regulated in the same way as other tobacco products."
In 2017,
Mitchell H. Katz
Mitchell H. Katz (born December 29, 1959) also known as Mitch Katz) is the President and CEO of New York City Health and Hospitals, the largest public health care system in the United States.
Early life and education
Katz was raised in Brooklyn ...
, director of the
Los Angeles County Health Agency, wrote: "There is concern that heat-not-burn tobacco will skirt local ordinances that prevent smoking in public areas."
Tobacco control
Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use ...
activist
Stanton Glantz stated that the US FDA should halt new tobacco products until tobacco companies stop selling traditional cigarettes. It is recommended that indoor-smoking bans for traditional cigarettes be extended to heated tobacco products.
It is recommended that marketing of these products, and claims being made about them, should be regulated.
Advertisement for the IQOS product itself is not regulated under the European Union
Tobacco Products Directive
The Tobacco Products Directive (TPD) or European Tobacco Products Directive (EUTPD) (2014/40/EU) is a directive of the European Union which places limits on the sale and merchandising of tobacco and tobacco related products in the EU. The TPD aim ...
, though the directive may apply to advertising for the IQOS' tobacco stick.
The UK government has been looking into creating a separate category for taxing heated tobacco products.
Due to the alleged belief in heated tobacco harm reduction in Italy, HTPs are exempted from the fiscal regimes of tobacco products. Taxes on them are reduced as much as e-cigarettes, or half of traditional cigarettes. Moreover, the enforcement of various tobacco control regulations is only minimally adopted for HTPs in Italy: health warnings are required to cover only 30% of the heated tobacco product packaging (instead of 65% for traditional cigarettes), without pictorial images; comprehensive smoke-free regulations prohibiting smoking in all public places and workplaces do not apply to HTPs; and advertising and promotions are not banned for them. Epidemiologists Xiaoqiu Liu ''et al.'' note the lax enforcement over HTPs have been exploited by the presence of "IQOS embassies" and "IQOS boutiques"—fancy concept stores where IQOS is promoted as a status symbol and free samples are given—and believe the most recognized tobacco control policies in Italy (i.e., price/tax increase, smoking bans, advertising bans, and health warnings) have been compromised by HTPs.
HTPs are not restricted for sale in Israel by the
Ministry of Health.
The Justice Ministry in Israel agreed with the view of three voluntary organizations that the IQOS is a tobacco product, and that it should be regulated in the same manner as tobacco products. In Israel the IQOS is taxed at the same rate as traditional cigarettes.
Ploom, IQOS, and glo fall under the Tobacco Business Act as tobacco products in Japan because they consist of tobacco leaf.
Ploom and IQOS are governed by the Tobacco Industries Act regulations as tobacco products in Japan.
The
Liberal Democratic Party will deliberate over increasing the tax rate for heated tobacco products in April 2018.
Electronic tobacco products using dry material are regulated as e-cigarettes in South Korea by the
Ministry of Health and Welfare,
which are regulated differently than traditional cigarettes for tax reasons.
As a result, IQOS are taxed at a lower rate when compared to the 75% incurred on normal cigarettes.
Emerging tobacco products are banned in Singapore by the
Ministry of Health.
China plans to pass legislation to ban the sale of these products to minors, as of 2019.
After IQOS launched a marketing campaign in New Zealand in December 2016, the country's
Ministry of Health stated in 2017 that the refill sticks are not legal for sale in New Zealand under the
Smoke-free Environments Act 1990
The Smokefree Environments and Regulated Products Act 1990 (originally the Smoke-free Environments Act 1990) is an Act of Parliament in New Zealand. The Act placed smoking restrictions on indoor spaces, banned smoking on public transport and es ...
.
A representative for the company in New Zealand stated that IQOS products comply with the Smoke-Free Environments Act.
Three meetings between Ministry of Health officials and people from the tobacco industry were held from 30 May 2017 through 2 June 2017 to "discuss regulation of new tobacco and nicotine-delivery products". In August 2017, the government stated they would initiate a review process before products are sold for heated tobacco products such as IQOS.
In 2018, PMI and the Ministry of Health were in a legal dispute over the legality of selling IQOS in New Zealand,
before a New Zealand court decided in March that the HEETs sticks used in the IQOS product are legal to sell in the country.
Individuals can import heated tobacco products to New Zealand for personal use.
, 49 countries have permitted the sale of IQOS.
Notes
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References
External links
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{{Electronic cigarettes
Cigarette types
Products introduced in 2014
Philip Morris brands
Tobacco smoke carcinogens
Nicotine products with harm-reduction claims
Electronic cigarettes