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What Are Heated Tobacco Products? – Expert Q&A
They’re not vapes, and they’re not cigarettes. So what are the heated tobacco products that have had their excise tax slashed in half?
The Government has recently agreed to set aside $216 million it may need to pay for the tax cuts.
The SMC asked experts to comment on how heated tobacco products work, how they’re marketed, and what the evidence says about how helpful they are as a tool to quit smoking.
Professor Chris Bullen, School of Population Health, University of Auckland, comments:
“Heated tobacco products (HTPs) are battery-operated tobacco products made by some of the world’s largest tobacco companies that heat, rather than burn tobacco.
“Heating the tobacco sheet or plugging in an HTP generates a vapour that contains nicotine, which the user inhales.
“They don’t produce smoke because no burning is involved. This is a good thing, potentially, from a health risk perspective. However, just how less harmful they are, compared to conventional cigarettes, is uncertain. Almost all of the research on the potentially toxic chemicals contained in HTP vapour comes from tobacco companies’ researchers, not from independent researchers.
“They may look like some models of e-cigarettes (vapes) but are quite different products. Vapes work by heating and aerosolising a liquid, usually containing nicotine, into a vapour for inhalation. Vapes do not use, heat or burn tobacco. Vaping has been shown in rigorously conducted trials and meta-analyses of trials to aid people in quitting smoking, when used with nicotine liquid and used daily, about as well as the most effective pharmaceutical smoking cessation treatments.
“There is no evidence that HTPs help people quit smoking. If HTPs were shown in well-conducted trials to help people who smoke cigarettes to quit smoking, that would be potentially a positive outcome. However, to date, no independent research has found this to be the case. Rather, the evidence suggests that people who use HTPs continue smoking and using HTPs.
“By cutting the excise tax on them in half, ostensibly to help promote switching from smoking and reduce smoking to achieve the Smokefree 2025 goal, the Minister has failed to follow the evidence and given a shot in the arm to the tobacco industry.”
Conflict of interest statement: “Prof Bullen has never received funding from the tobacco or vaping industries. He holds research contracts with the Ministry of Health and Education NZ and is a co-investigator on grants from the NZ Health Research council, Cure Kids, Marsden Fund, NHMRC (Australia), Wellcome Trust UK and NIH (US). He is immediate past President of the Society for Research in Nicotine and Tobacco.”
Janet Hoek, Professor of Public Health, Co-Director ASPIRE Aotearoa, University of Otago, comments:
What are heated tobacco products and how do they work?
“Heated tobacco products (HTPs) heat tobacco sticks to create an emission that contains nicotine and other chemicals. Unlike smoked tobacco such as cigarettes, which involve burning or combustion, HTPs do not combust the tobacco sticks; as a result, tobacco companies claim the emissions contain fewer toxins relative to smoked tobacco. However, because tobacco companies have conducted much of the research into HTPs, some public health groups have questioned whether the findings are accurate and disinterested.”
How do heated tobacco products differ from e-cigarettes or vaping?
“Heated tobacco products heat a tobacco stick whereas e-cigarettes aerosolise e-liquid. People using an HTP inhale the emission created by heating whereas people using e-cigarettes inhale an aerosol formed after heating the e-liquid.
“Because HTPs comprise a device that does not contain tobacco and tobacco sticks, they are regulated in a hybrid manner. The HTP device has been regulated as a vaping device while the sticks have been treated as tobacco products for excise tax purposes (until the decision to halve the excise tax). This hybrid approach means that HTP devices may be displayed in stores (just as vaping products may be displayed).”
How are heated tobacco products currently marketed?
“Internationally, HTPs are marketed on social media using event and price promotions. The products have a sleek up-market design that looks technically advanced and clean, thus reinforcing claims they pose fewer health risks than smoked tobacco products. HTPs have similar attributes to other high tech gadgets and appear likely to appeal to young people, in the same way that pod and disposable e-cigarettes do.
“The products are sold from physical stores that look high tech, which is likely to arouse curiosity among young people who may be exposed to products from outside the store. In a past study, we found that IQOS marketing used statements that encouraged dual use of HTPs and e-cigarettes.
“The NZ IQOS site offers free trial promotions and discounts to encourage trial (i.e., reducing the financial risk of trialling the product), and runs a loyalty club offering a $5 reward to people who sign up to the club. The site also claims that HTPs have 95% less harmful chemicals (though differentiates that claim from a 95% risk reduction claim).
“Given the way HTPs are marketed, I agree with the Ministry of Health, which advised: ‘We do not recommend liberalising the way HTPs are promoted. This would likely compound existing concerns about youth uptake and addiction to nicotine products’ (paragraph 90 in linked reference).”
What evidence is there regarding HTPs’ use for harm reduction or smoking cessation?
“In its advice to the Associate Health Minister (cited above), the Ministry of Health reported that ‘there is little independent evidence to support their use as an appropriate reduced-harm alternative to smoking. There is no evidence to support their use as a quit smoking tool’ (see paragraphs 86 onwards).
“I note that a recent study of people in Japan who used HTPs concluded that ‘HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.'”
Conflict of interest statement: “Janet Hoek receives funding from the Health Research Council and NZ Cancer Society; she has previously received funding from the Marsden Fund (Royal Society of New Zealand). She co-directs ASPIRE Aotearoa, a research centre whose members develop and test evidence supporting tobacco endgame measures. She is a member of several advisory committees, including the Health Coalition Aotearoa, and international government and NGO groups.”
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