18C.4 Potential risks/benefits to public health

Last updated: March 2018         

Suggested citation: Greenhalgh, EM. 18C. Heated tobacco (‘heat-not-burn’) products. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2018. Available from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18c-non-combustible-cigarettes/18c-4-potential-risks-benefits-to-public-health

The introduction and growing popularity of heated tobacco products presents challenges to the public health and tobacco control communities similar to those stemming from the growth of e-cigarette use.1 As with e-cigarettes, the recency of heated tobacco products means that their long-term health effects are largely unknown. Similarly, there is insufficient evidence regarding their usefulness as a smoking cessation aid vs. their likelihood to be used concurrently with cigarettes, or their potential to attract young never smokers or serve as a ‘gateway’ to combustible cigarettes.2 One independent study found that while the use of heated tobacco products reduced the severity of abstinence symptoms in cigarette smokers, it was perceived as less satisfying than smoking the participants’ own brand of cigarettes, potentially increasing the likelihood of supplementation (i.e., dual use). Also, given that the products deliver nicotine, they have the potential for creating and/or maintaining nicotine dependence in the user.3  

The involvement of the tobacco industry in research and regulations concerning ‘reduced-risk’ or cessation products is of concern to public health experts. Claims by the tobacco industry that its goal is for smokers to switch to ‘safer’ products have been met with scepticism. For example, Philip Morris International claims that it wants to ‘quit smoking’ and that ‘the greatest contribution PMI can make to society is to replace cigarettes with less harmful alternatives’.4 However, it has made no active moves to cease selling cigarettes, and continues to fight effective tobacco control measures.5 Despite the lack of robust evidence, heated tobacco products have been advertised as reduced-risk tobacco products in their Japanese test market, and these marketing messages will likely spread to other markets even where such messaging is banned.1 Research independent of the industry is needed to evaluate potential risks to public health and individual consumers.6

Given their rapid growth in some markets, some have suggested that the tobacco control community could pre-empt the rising popularity of these products—and the associated risks to public health—by extending existing tobacco control strategies to encompass heated tobacco products, including the research and dissemination of messages regarding potential health risks, restricting advertising and promotion, and extending smokefree areas to protect bystanders from heated tobacco emissions.7 Banning characterising flavours and including the products in minimum age of purchase laws may also help prevent vulnerable young people from taking up the products.6  


1. Caputi T, Leas E, Dredze M, Cohen J, and Ayers J. They're heating up: Internet search query trends reveal significant public interest in heat-not-burn tobacco products. PLoS ONE, 2017; 12(10):e0185735. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29020019

2. World Health Organization. Heated tobacco products (HTPs) information sheet. 2017. Available from: http://www.who.int/tobacco/publications/prod_regulation/heated-tobacco-products/en/

3. Lopez AA, Hiler M, Maloney S, Eissenberg T, and Breland AB. Expanding clinical laboratory tobacco product evaluation methods to loose-leaf tobacco vaporizers. Drug and Alcohol Dependence, 2016; 169:33–40. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27768968

4. Philip Morris International. Sustainability report. 2017. Available from: https://www.pmi.com/resources/docs/default-source/pmi-sustainability/pmi_sustainability_report_2016.pdf?sfvrsn=143382b5_2

5. Hawkes N. Big Tobacco's New Year's resolution to quit smoking. British Medical Journal, 2018; 360:k79. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29305417

6. Jenssen BP, Walley SC, and McGrath-Morrow SA. Heat-not-burn tobacco products: Tobacco industry claims no substitute for science. Pediatrics, 2018; 141(1). Available from: https://www.ncbi.nlm.nih.gov/pubmed/29233936

7. Caputi TL, Leas E, Dredze M, Cohen JE, and Ayers JW. They're heating up: Internet search query trends reveal significant public interest in heat-not-burn tobacco products. PLoS ONE, 2017; 12(10):e0185735. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29020019 

      Previous Chapter Next Chapter