Symposium: Heat-not-burn tobacco products: Current Understanding

BACKGROUND: ‘Heat-not-burn’ tobacco products (HnB) are electronic devices that heat processed tobacco instead of combusting it to supposedly deliver an aerosol with fewer toxicants than in cigarette smoke. METHODS: Literature search was performed using MedLine, PubMed, PsycINFO and Embase for relevant English language articles published upto September 2020 RESULTS: As of February 2020, heated tobacco products were sold in at least 52 countries and the market for such products is anticipated to expand by 60% over the next 10 to 15 years. Total sales for HTPs in 2016 were US$ 2.1 billion, and they are expected to reach US$ 17.9 billion by 2021. The susceptibility to trying HnB (25.1%) was higher than for traditional cigarettes (19.3%), but lower than for e-cigarettes (29.1%). It has been seen that the awareness about HnB was higher in Japan and Korea compared to the western world. The concentration of TSNAs (Nitrosamines) was one fifth and CO was one hundredth of those of conventional combustion cigarettes in some studies. The levels of toxicants were at least 62% lower than in cigarette smoke and particulate matter (PM) was 75% lower than in conventional cigarette smoke. But it does not render that they are less harmful and it has lead to dual use with combustible cigarettes and marketing strategies directed towards youth. CONCLUSION: There is dearth of research regarding the effects on health and the claims of HTP emissions. The scientific evidence has revealed that there is no risk-free level of exposure to tobacco smoke. It should fall under the same comprehensive smoke-free policies applied to conventional tobacco cigarettes. Strict regulations are required for monitoring use among youth and on false marketing practices of tobacco industry.