Abstract
Heated tobacco products represent a novel category of tobacco products in which a tobacco consumable is heated to a temperature that releases nicotine from the tobacco leaf but not to a temperature sufficient to cause combustion. Heated tobacco products may therefore have the potential to be a less harmful alternative for adult smokers that would otherwise continue to smoke conventional cigarettes. Given the rapid development of this product category, the aim of this review was to examine the available peer-reviewed scientific evidence related to heated tobacco products and highlight any research gaps. In recent years, manufacturers of heated tobacco products have published a number of studies on their respective heated tobacco products. Whilst there is limited research that is independent of commercial interests, the available scientific evidence indicates that heated tobacco products produce a much simpler aerosol than conventional cigarette smoke, with fewer and substantially lower levels of harmful toxicants. Toxicology assessments indicate these reductions in aerosol toxicants translate to reduced biological effects. Biomarker and clinical data from studies in which product use is controlled within a clinical setting, indicate changes in biomarker levels and clinical end-points similar to observations in cessation studies, indicating the potential for reduced harm. The scientific evidence also indicates that exposure of non-users to emissions from heated tobacco products in indoor environments is significantly reduced compared to exposure resulting from smoking conventional cigarettes. Overall, the available scientific evidence indicates that heated tobacco products hold promise as a less harmful alternative to conventional cigarettes, but more independent data is required to validate industry findings. As a growing product category, epidemiological studies and independent population modelling studies are outstanding, and empirical data on how dual tobacco product category use by consumers affects their risk profile is lacking.
Highlights
The health effects associated with conventional cigarette smoking have been extensively documented by the public health and scientific communities (United States Surgeon General, 2010; International Agency for Research on Cancer, 2012; American Cancer Society, 2018)
With respect to chemical constituents and harmful and potentially harmful constituents (HPHCs), the data shown in Table 2 indicates that experimentally produced aerosols from heated tobacco products contain fewer and significantly lower levels of these chemical constituents compared to conventional cigarette mainstream smoke in almost all instances
Whilst some non-HPHC chemical constituents have been identified in aerosols from heated tobacco products at levels higher than those observed with conventional cigarette mainstream smoke, or have been quantified in aerosols from heated tobacco products but not in conventional cigarette mainstream smoke at all, the significance of these analytical observations to the toxicological profile of heated tobacco products remains unknown and requires further investigation (St Helen et al, 2018)
Summary
The health effects associated with conventional cigarette smoking have been extensively documented by the public health and scientific communities (United States Surgeon General, 2010; International Agency for Research on Cancer, 2012; American Cancer Society, 2018). It is important to acknowledge that population level tobacco harm reduction can only be achieved if a scientifically-substantiated reduced harm product is accepted and used by a large number of adult smokers, who would otherwise continue to smoke, while never smokers, vulnerable populations and youth do not begin using it. One such innovative product category within NGPs are heated tobacco products, known as ‘heat-not-burn’ tobacco products. Consumer interest in heated tobacco products continues to increase as demonstrated by a rise in internet search engine searches relating to them (Caputi et al, 2017; Stall et al, 2018; Tabuchi et al, 2018) and an increased discussion of them on social media platforms (Hejlová et al, 2019; Kreitzberg et al, 2019; Jun, 2020; Barker et al, 2021)
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