The tobacco market has been undergoing a quiet but powerful revolution for the last decade with the emergence of “Heated Tobacco Products” (HTPs). These devices appeal to a growing number of smokers looking for an experience similar to cigarettes, but without burning tobacco. However, behind the technological innovation lies a major public health controversy.
What is Heated Tobacco?
Unlike traditional cigarettes, which burn tobacco at temperatures exceeding 800 °C, heated tobacco systems use an electrical resistor to heat the tobacco to a much lower temperature, generally between 250 and 350 °C. This process generates an aerosol rich in nicotine and flavorings, without reaching the threshold of combustion.
The major players in this market are the tobacco giants. IQOS (produced by Philip Morris International), Ploom (Japan Tobacco International) and Glo (British American Tobacco) dominate the offer, using specially treated small tobacco cigarettes (called “sticks” or “refills”).
Aerosol vs. Smoke: The Chemical Difference
The main selling point of HTPs is based on the absence of combustion. Combustion is indeed responsible for producing the majority of the toxins contained in cigarette smoke, such as carbon monoxide, tar, and polycyclic aromatic hydrocarbons.
It is true that the aerosol generated by heated tobacco exhibits significantly reduced levels of toxic substances compared to conventional cigarette smoke, with reductions ranging from 80% to over 95% for certain compounds. However, the aerosol is not devoid of harmful substances. It still contains nicotine, as well as volatile organic compounds and other potentially dangerous chemicals, albeit in smaller quantities. Even if there is no combustion, there is pyrolysis, and the aerosol can be still qualified as smoke. It is by no means clean air.
Impact on Exposure and Health
Heated tobacco users therefore inhale a lower quantity of toxins, and the US FDA (Food and Drugs Administration) authorized PMI, the manufacturer of IQOS, to advertise it as a reduced-exposure product (but not reduced-risk). However, users maintain a level of nicotine exposure comparable to that of a cigarette. The essential public health question is whether this reduction in exposure translates into a significant reduction in risk. Long-term data is sorely lacking to answer this crucial question. Independent health organizations, such as the World Health Organization (WHO), emphasize that HTPs are not harmless and that it is impossible, at this stage, to quantify the actual risk reduction compared to conventional cigarettes. Switching from cigarettes to heated tobacco means replacing a very high risk with an undetermined risk. Only complete cessation of tobacco eliminates the risk.
Does Heated Tobacco Help Quitting Cigarettes ?
Current data are insufficient to confirm or refute the claim that using heated tobacco increases the chances of quitting smoking. Some users may engage in dual use (smoking cigarettes and using HTPs), a pattern that may be a useful intermediate step toward quitting smoking, even if it does not offer any health benefits in itself.
However, HTPs are one of the most frequently used aids by people who have successfuly quit smoking, and some initial rersearch suggests that they are effective as smoking cessation aids.
The Japan Effect
The impact of heated tobacco on the market in Japan has been spectacular. Following the introduction of IQOS in 2014, sales figures rose steadily, while cigarette sales in Japan fell by half. The market share of HTPs is now roughly equal to that of cigarettes. It is very likely that there is a causal link between these two events. In other regions, such as the United States or Europe, prevalence of use remains lower, but it is increasing.
Overall Impact
The overall public health impact is debated. Advocates of harm reduction argue that even a slight reduction in toxins for smokers who cannot quit is progress. Opponents fear that the existence of these products undermines prevention efforts by making tobacco use more socially acceptable, hinders complete cessation, and creates a new generation of nicotine users, even though HTPs are seldom used by never-smokers.
References
Auer R, Concha-Lozano N, Jacot-Sadowski I, Cornuz J, Berthet A. Heat-Not-Burn Tobacco Cigarettes: Smoke by Any Other Name. JAMA Intern Med. 2017;177(7):1050–1052. doi:10.1001/jamainternmed.2017.1419
Cummings KM, Roberson A, Levy DT, et al. Transformation of the tobacco product market in Japan, 2011–2023. Tobacco Control Published Online First: 29 October 2024. doi: 10.1136/tc-2024-058734
Caponnetto P, Campagna D, Maglia M, Benfatto F, Emma R, Caruso M, Caci G, Busà B, Pennisi A, Ceracchi M, Migliore M, Signorelli M. Comparing the Effectiveness, Tolerability, and Acceptability of Heated Tobacco Products and Refillable Electronic Cigarettes for Cigarette Substitution (CEASEFIRE): Randomized Controlled Trial. JMIR Public Health Surveill. 2023 Apr 4;9:e42628. doi: 10.2196/42628. PMID: 37014673; PMCID: PMC10131829.
Jackson SE, Brown J, Buss V, Shahab L. Prevalence of Popular Smoking Cessation Aids in England and Associations With Quit Success. JAMA Netw Open. 2025;8(1):e2454962. doi:10.1001/jamanetworkopen.2024.54962
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