Heated tobacco products produce an emission containing nicotine and many other chemicals from tobacco, which is inhaled by users. Although they may look like e-cigarettes, heated tobacco products actually contain tobacco, whereas e-cigarettes heat a tobacco-free liquid that usually contains nicotine.
Heated tobacco products differ from cigarettes and other tobacco products that are set alight; they are not lit but heated to a lower temperature to produce their aerosol emissions. Proponents argue that this difference produces a less harmful, “smoke-free” emission, despite there being very little difference between this emission and tobacco smoke (see InDepth 18B.5), and no direct evidence for reduced health risks (see InDepth 18B.6).
While there is no legal market in Australia (see InDepth 18B.9), heated tobacco products are sold in at least 64 countries/markets, with the global market in 2022 worth US $32.4 billion (see InDepth 18B.2).1 They are stylish in design, aggressively marketed online and often targeted to youth (see InDepth 18B.3). Their advertising makes claims of being a harm-reduction product that can aid cigarette cessation, despite no good quality evidence for either. A growing number of independent studies raise doubts about the usefulness of these products as a smoking cessation aid.2-4 Rather they are being used concurrently with cigarettes, and they may attract young never smokers or serve as a ‘gateway’ to combustible cigarettes (see InDepth 18B.7).
These issues have led to public health experts and major health bodies generally calling for caution around their introduction, use, and regulation. The World Health Organization (WHO) recognises heated tobacco as a tobacco product and has stated that these products should be subject to relevant policy and regulatory measures, in line with the WHO Framework Convention on Tobacco Control (see InDepth 18B.10).5
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References
1. Tobacco Free Kids. Heated tobacco products: Definitions and global markets. 2023. Available from: https://assets.tobaccofreekids.org/emerging-products/resources/HTPs-Definitions.pdf.
2. Hwang JH, Ryu DH, and Park SW. Heated tobacco products: Cigarette complements, not substitutes. Drug and Alcohol Dependence, 2019; 204:107576. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31586808
3. 4 big concerns about selling IQOS heat-not-burn cigarettes in the US. Truth Initiative, 2018. Available from: https://truthinitiative.org/news/4-big-concerns-about-selling-iqos-heat-not-burn-cigarettes-us
4. Harada S, Sata M, Matsumoto M, Iida M, Takeuchi A, et al. Changes in smoking habits and behaviors following the introduction and spread of heated tobacco products in Japan and its effect on FEV(1) decline: A longitudinal cohort study. Journal of Epidemiology, 2022; 32(4):180-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34657910
5. World Health Organization. Heated tobacco products: information sheet - 2nd edition. 2020. Available from: https://www.who.int/publications/i/item/WHO-HEP-HPR-2020.2