New ideas, old problems? Heated tobacco products – a systematic review

Abstract

Heated tobacco products (HTPs) are a form of nicotine delivery intended to provide an alternative to traditional cigarettes. The aim of this systematic review was to present the current state of knowledge on HTPs with an emphasis on the potential impact of HTP use on human health. During the preparation of this systematic review, the literature on HTPs available within Medline/PubMed, EMBASE, CINAHL, ScienceDirect, and Google Scholar was retrieved and examined. In the final review, 97 research papers were included. The authors specifically assessed the construction and operation of HTPs, as well as the chemical composition of HTP tobacco sticks and the generated aerosol, based on evidence from experimental animal and cellular studies, and human-based studies. Heated tobacco products were found to generate lower concentrations of chemical compounds compared to traditional cigarettes, except for water, propylene glycol, glycerol, and acetol. The nicotine levels delivered to the aerosol by HTPs were 70-80% as those of conventional combustion. The results of in vitro and in vivo assessments of HTP aerosols revealed reduced toxicity, but these were mainly based on studies sponsored by the tobacco industry. Independent human-based studies indicated that there was a potentially harmful impact of the active and passive HTP smoking on human health. Currently, a large body of knowledge on HTP exposures and health effects is provided by the tobacco industry (52% of identified studies). Based on the available evidence, HTPs produce lower levels of toxic chemicals, compared to conventional cigarettes, but they are still not risk-free. Int J Occup Med Environ Health. 2019;32(5):595 -634

Effects of tobacco cigarettes, e-cigarettes, and waterpipe smoking on endothelial function and clinical outcomes

“…Some basic facts on heat-not-burn tobacco products (e.g. iQOS), their regulation and data on their toxicity were reviewed previously 17 and more details can be found in the Supplementary material online .…”

Impact of Electronic Alternatives to Tobacco Cigarettes on Indoor Air Particular Matter Levels

“…Even if the association between the use of EATCs and adverse effects for human health is still under debate, there are several recent evidences of possible negative outcomes [13][14][15]. In addition to the possible adverse effects for active smokers of EATCs (the so-called vapers), experimental evidences demonstrate that the use of these devices worsen indoor air quality determining a typical passive exposure also called Environmental Electronic Vape (EEV) exposure [16][17][18]. The results of our previous researches [2,[19][20][21] highlighted that EEV exposure to particulate matter (PM) always occurs when e-cigs are used in indoor settings.…”

Awareness of Marketing of Heated Tobacco Products and Cigarettes and Support for Tobacco Marketing Restrictions in Japan: Findings from the 2018 International Tobacco Control (ITC) Japan Survey

“…High exposure to HTP and cigarette advertising are consistent with the absence of a comprehensive advertising ban on tobacco products in Japan and evidence from other countries on exposure to tobacco advertising in unregulated channels. Pervasive global HTP marketing through prominent displays in convenience stores, duty-free stores, dedicated IQOS boutique stores, Internet and social media channels such as Instagram, Facebook, and Twitter and a spectrum of other youth-oriented events are well described in recent reviews [13,40,41]. Between 2017 and 2019, PMI reported a three-fold increase in the number of stand-alone IQOS stores worldwide from 63 to 199 and more than twice the number of retailers selling HTPs from 292 to 679 [42].…”

“…Although there is some evidence that HTPs may involve some partial combustion [7], the tobacco industry argues that because HTPs do not involve combustion, they are potentially less harmful than combustible cigarettes [8][9][10]. While several independent studies have reported significantly lower emissions of some chemicals/toxicants from HTPs, it is not clear whether reduced exposure means reduced risk to HTP users [7,[11][12][13][14].…”