Heated Tobacco Products
What are heated tobacco products
- Heated tobacco products (HTPs) generate nicotine-containing aerosol with an electronic heating device that heats specially designed cigarettes or ground tobacco leaves at around 300℃.
- Similar to conventional cigarettes, HTPs contain tobacco as the main ingredient which deliver addictive nicotine and harmful and carcinogenic substances to users, and cause smoking attributed diseases.
- All smoking products, including HTPs, are harmful. Tobacco is inherently toxic and contains carcinogens even in its natural form. There is no safe level of exposure to tobacco smoke, any exposure can harm health.
- Similar to conventional cigarettes, HTPs release harmful substances such as nicotine, tar, formaldehyde, acetaldehyde, acrolein, acrylamide, tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, heavy metals and volatile organic compounds, etc. Many of them are toxic or carcinogenic.
- According to a review by The Food and Drug Administration of the United States (FDA), 80 chemicals are unique to HTP aerosol or present in higher levels than in conventional cigarette smoke, including 4 possibly carcinogenic, 15 potentially genotoxic and 20 with potential health effects. Some were more than 200% or even more than 1000% higher in HTP aerosol than in conventional cigarette smoke.
- The World Health Organization (WHO) reiterated that some harmful substances in HTP aerosol are in higher levels than or even absent in cigarette smoke. Exposure reduction claims of HTPs may be misleading.
- Even without combustion, the heating temperature of HTPs are high enough to melt the polymer-film filter in HTP sticks, releasing formaldehyde cyanohydrin, which can be metabolized into carcinogenic formaldehyde and toxic cyanide.
- Despite authorization of the sales of an HTP with “Exposure Modification” claims based on complete switching from conventional cigarettes to the HTP, FDA did not approve its “Risk Modification” or harm reduction claims.
- FDA emphasized that HTPs are neither safe nor “FDA approved”, and concluded that there was insufficient evidence to show improved health risks in smokers switching to HTPs.
- HTPs are often marketed as a trendy product, and are appealing to young people. HTPs may be a gateway to conventional cigarette smoking in young people who have never smoked.
Secondhand and third-hand aerosol
- Similar to conventional cigarettes, HTPs expose bystanders to secondhand smoke.
- Secondhand aerosol of HTPs exposes bystanders to a wide range of harmful substances such as nicotine, formaldehyde, acetaldehyde and acrolein.
- Similar to secondhand smoke of conventional cigarettes, secondhand aerosol of HTPs may linger on dust and surfaces before re-mitted into the air, leading to third-hand aerosol exposure.
HTPs do not help smoking cessation
- HTPs do not help smoking cessation although they are often marketed as an alternative to conventional cigarette smoking. HTPs should not be considered as another choice for smoking.
- Majority of HTP users concurrently smoke conventional cigarettes. Instead of a substitute for conventional cigarettes, HTPs are more likely a complementary product that smokers use to satisfy the desire for nicotine when smoking is not allowed or suitable. Dual users may thus be exposed to higher levels of nicotine and other harmful substances.
- Local and foreign research show that HTP use is not associated with intention to quit, quit attempts or cigarette abstinence in current smokers.
- Smokers should abstain from all tobacco and nicotine products. If needed, they should seek recognized cessation aid, such as cessation counselling and nicotine replacement therapy.
Situation in Hong Kong
- According to the Thematic Household Survey Report No.70 published by Census and Statistics Department, about 13,100 people aged 15 years or above were daily users of HTPs in 2019, accounting for 0.2% of the Hong Kong population. In Primary 4-6 and Secondary 1-6 students, 0.1% and 0.5% were current HTP users in 2018/19, respectively.
- According to Smoking (Public Health) Ordinance (Cap. 371), HTP use in statutory no-smoking areas is prohibited. Offenders are liable for a fixed penalty of HK$1,500 fine.
- Since 30 April 2022, it is an offence to import, promote, manufacture, sell or possess for commercial purposes HTPs. Offenders are liable for a HK$50,000 fine and 6-month imprisonment. Broadcast of a HTP advertisement is liable for a HK$50,000 fine, with an extra HK$1,500 fine per day for continuing offences.
Stance of overseas and regulatory bodies and health authorities
- Regulations of HTPs vary across countries. About 20 countries and regions (e.g. Finland, India,Singapore, Thailand and Macau) ban HTPs, while about 40 countries (e.g. South Korea and the US) put HTPs under the existing tobacco control framework.
- WHO reiterates that reduction of harmful substances in HTPs would not render them harmless or less harmful, and recommends regulations or even prohibition of HTPs.
- International Union Against Tuberculosis and Lung Disease recommended protective and preventive bans on HTPs in low and middle income countries, where there is strong potential for HTPs to overwhelm the governments and exacerbate the tobacco epidemic.
- European Respiratory Society stated that HTPs are harmful and highly addictive, and smokers may switch to HTPs instead of quitting. Any products that can damage lung and human health cannot be recommended.
- The Health Ministry of Italy rejected the application for classifying a HTP as a harm reduction product, stating that there was insufficient evidence of the harm reduction claims and it was not possible to recognize the reduction of toxic substances compared with combustible tobacco products.
- FDA rejected the harm reduction claims of HTPs, and emphasized that HTPs are neither safe nor “FDA approved”.
- Therapeutic Goods Administration of Australian Department of Health reiterates that there are significant safety concerns with HTPs and there is no net public health benefit from the introduction of HTPs.
To prevent the use of HTPs and the potential health risks associated with their secondhand smoke, as well as to prevent HTPs from being a gateway to smoking in youths, COSH suggests to impose a total ban on HTPs as soon as possible.