Heated tobacco products have proved to be highly effective at replacing cigarette smoking in countries with vaping restrictions, such as Japan, says a new briefing paper from the Global State of Tobacco Harm Reduction (GSTHR).
The paper is intended as a primer on heated tobacco products, providing an overview of how they work and their reduced risk profile. Heated tobacco products (HTP) – also known as ‘heat-not-burn’ products – are non-combustible safer nicotine devices that use an electronic heating element to heat sticks of tobacco, producing a nicotine vapour for inhalation in a manner similar to vaping.
While tobacco is burned in cigarettes – producing more than 4,000 chemical products, at least 70 of which are known carcinogens – HTP use a battery and heating element to heat the tobacco below its combustion point. Just under 70 countries currently allow the sale of HTP, the leading brands of which include Ploom, IQOS and glo, with one in three users reporting that they buy the products to help reduce or quit smoking.
‘Key market data sheds some important light on the impact HTP are having on the sale of cigarettes,’ the document says, with ‘a clear substitution effect’ taking place in some European markets – driven in part by high rates of tax on cigarettes. In Japan, however – where vapes are banned unless licensed as a medical product – research by GSTHR shows that cigarette sales have fallen by more than 50 per cent since the introduction of HTP just over a decade ago.
The regulatory framework for HTP varies widely, from full-scale bans – in countries including Australia, Brazil and China – through strict regulation to open availability. While the World Health Organization has taken a hardline stance on HTP – classing them as ‘inherently toxic’ products alongside cigarettes and cigars – and the EU’s tobacco products directive has banned all flavoured HTP, a 2018 Public Health England evidence review concluded that HTP were likely to be significantly safer than cigarettes. ‘Compared with cigarette smoke, HTP are likely to expose users and bystanders to lower levels of particulate matter and harmful and potentially harmful compounds,’ it said.
‘Heated tobacco products have proved to be highly effective in replacing cigarette smoking in countries such as Japan, where vaping restrictions have helped to boost their appeal to consumers – so much so that heated tobacco products have now become the dominant safer nicotine product by market share,’ the GSTHR briefing paper states. ‘Their steady rise in popularity has helped shift people who smoke onto these less-harmful alternatives, with national public health bodies citing these products as playing a role to help reduce smoking rates. Influential public health research such as the Cochrane Review 2022 have widely agreed that heated tobacco products expose users to lower levels of key toxins and carcinogens than are otherwise found in combustible tobacco smoke.’
However, the relative lack of independent research into their safety means there is still significant opposition, it continues, with a consequent difficulty in ‘separating these products from the devastating impact of combustible tobacco use. With some regulators looking to tighten restrictions on the sale of these products, their future – as with some other safer nicotine products – is uncertain. But the real-world impact of these products in helping reduce cigarette consumption highlights their potential to play a key role in tobacco harm reduction efforts across the globe.’
Meanwhile, a new study suggests there may be a ‘tipping point’ at which smoking-related lung damage becomes more likely to be irreversible. Taking a measure of a ‘pack year’ as equating to 20 cigarettes a day for a year, the study – by TidalSense – indicated a potential tipping point of 25 years, after which ‘the likelihood of retaining normal lung function decreases significantly’. The study used capnography data, which measures the concentration of carbon dioxide over time, and found ‘markedly worse’ airway disease indicators after 40 pack years.
According to figures published earlier this month by UCL, more than a million people in the UK quit smoking last year, while research by ASH shows that more than half of current smokers would like to stop. The number of vapers in the UK has now overtaken the number of smokers for the first time. The Tobacco and Vapes Bill – which aims to create a ‘smokefree generation’ by phasing out the legal sale of tobacco to anyone born after January 2009, as well as tightening the regulations around vape flavours and packaging – has passed its final stage in the House of Lords and is expected to be passed into law in the coming weeks.
This year’s Global Forum on Nicotine takes place in Warsaw on 3-5 June 2026. Full details available here
What are heated tobacco products is available here
Quantification of smoking-related airway remodelling in COPD, using N-Tidal is available here