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Temperature zones in a combustible cigarette (A) in comparison to different Heated Tobacco Products (B).

Temperature zones in a combustible cigarette (A) in comparison to different Heated Tobacco Products (B).

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The health risks of tobacco smoking have been documented in numerous studies and smoking rates have declined in developed countries over the last 50 years. Today, we know that cigarette smoking is the major cause of preventable deaths due to tobacco smoke induced diseases. As a consequence of an increased awareness of smoking-related health risks,...

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Tobacco harm reduction is increasingly recognized as a promising approach to accelerate the decline in smoking prevalence and smoking-related population harm. Potential modified risk tobacco products (MRTPs) must undergo a rigorous premarket toxicological risk assessment. The ability to reproducibly generate, collect, and use aerosols is critical f...

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... Heated tobacco products (HTPs) are an emerging class of inhaled, non-combustible tobacco products that heat but do not burn processed tobacco [16]. Currently, only two HTPs (IQOS and Eclipse) are authorized for marketing in the US [17]. ...
... Since they do not generate combustion-related toxicants, HTPs are potentially less harmful than combustible cigarettes. Several studies have shown that the aerosol generated from HTPs contains fewer and lower quantities of toxicants compared to combustible cigarettes [18,19] (and reviewed in [16]). ...
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Heated tobacco products (HTPs) are a class of non-combustible, inhaled tobacco products with the potential to reduce the harm associated with cigarette smoking due to reduced cigarette smoke toxicant exposure. Subjective and nicotine pharmacokinetics measures taken over the course of product use provide a framework for abuse liability (AL) assessment of tobacco and nicotine products as well as information on adoption potential for a new tobacco product, which are important aspects for premarket tobacco product authorization by the US Food and Drug Administration. This study aimed to assess the AL of glo HTPs, operated in either Standard or Boost Modes, compared with high- and low-AL comparators (subjects’ usual brand cigarettes and nicotine gum, respectively). Nicotine uptake and pharmacodynamics measures (including subjective and physiological measures) were assessed in a clinical study of 75 healthy adult non-menthol or menthol smokers using an open-label, randomized crossover study design. Comparisons were made between glo HTPs (Standard or Boost Modes) and each of usual brand (UB) cigarettes and nicotine gum to evaluate nicotine exposure and subjective effects measures. Nicotine uptake, as reflected in the area under the curve (AUC) at 15 and 240 min after product use (AUC0-15 and AUC0-240, respectively) and maximum nicotine concentration (Cmax) were significantly lower for all glo HTPs compared to UB cigarettes, regardless of the glo device mode. AUC0-15 values for glo HTPs ranged from 41.26 to 75.71 ng × min/mL, versus 158.04 to 165.53 ng × min/mL for UB cigarettes. Similarly, AUC0-240 values for glo HTPs ranged from 379 to 596 ng × min/mL, compared to 1123.73 and 1283.37 ng × min/mL for UB cigarettes. The Cmax for glo HTPs ranged from 5.46 to 9.00 ng/mL, whereas UB cigarettes had Cmax values of 16.29 to 16.76 ng/mL. The time to reach maximum nicotine concentration (Tmax) was significantly shorter for glo HTPs (4–5 min) compared to UB cigarettes (6–7 min), except for one variant of glo HTP in Standard Mode. Nicotine gum exhibited a slower nicotine absorption profile, with a Tmax of 45 min and Cmax of 4.60 ng/mL. AUC0-15 and AUC0-240 values for nicotine gum were 6.18 and 5.22 ng × min/mL, and 647.80 and 687.68 ng × min/mL for non-menthol and menthol groups, respectively. Subjective measures indicated that glo HTPs were rated significantly lower than UB cigarettes in terms of product liking, smoking urge reduction, product effects, and intent to use again, but were comparable to nicotine gum. glo HTPs demonstrated lower AL than combustible cigarettes while delivering sufficient nicotine to support product adoption among current smokers. This positions glo HTPs as a potential tool in tobacco harm reduction, offering a less harmful alternative to traditional cigarettes. Clinical trial ID NCT05114863.
... Dostępne wyniki badań na modelach komórkowych i zwierzęcych oraz badań oceniających krótkoterminowe efekty narażenia na aerozol z e-papierosa u ludzi wykazały, że aerozol z e-papierosa podrażnia drogi oddechowe, wywołuje przewlekły stan zapalny w układzie oddechowym, zaburza funkcjonowanie komórek układu oddechowego, uszkadza śródbłonek naczyń krwionośnych, indukuje stres oksydacyjny, zwiększa sztywność naczyń i podnosi ryzyko tworzenia skrzepów [7,8,23]. Użyciu produktów podgrzewających tytoń towarzyszy niższa emisja związków chemicznych w porównaniu do palenia tradycyjnych papierosów, z wyjątkiem wody, glikolu propylenowego i glicerolu, których zawartość w głównym strumieniu dymu jest wyższa w przypadku podgrzewanego tytoniu niż w tradycyjnych papierosach [13,14,24]. Niemniej jednak w aerozolu z podgrzewaczy tytoniu oprócz nikotyny wykryto również lotne związki organiczne, wielopierścieniowe węglowodory aromatyczne, N-nitrozaminy, formaldehyd, acetaldehyd oraz akroleinę [13,14,24]. ...
... Użyciu produktów podgrzewających tytoń towarzyszy niższa emisja związków chemicznych w porównaniu do palenia tradycyjnych papierosów, z wyjątkiem wody, glikolu propylenowego i glicerolu, których zawartość w głównym strumieniu dymu jest wyższa w przypadku podgrzewanego tytoniu niż w tradycyjnych papierosach [13,14,24]. Niemniej jednak w aerozolu z podgrzewaczy tytoniu oprócz nikotyny wykryto również lotne związki organiczne, wielopierścieniowe węglowodory aromatyczne, N-nitrozaminy, formaldehyd, acetaldehyd oraz akroleinę [13,14,24]. Badania naukowe na temat skutków zdrowotnych używania e-papierosów i podgrzewaczy tytoniu oraz porównania szkodliwości papierosów, e-papierosów i podgrzewaczy tytoniu nadal trwają. ...
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Wprowadzenie i cel: Rynek wyrobów nikotynowych uległ dynamicznej zmianie. Wprowadzenie nowych form wyrobów nikotynowych, takich jak papierosy elektroniczne (e-papierosy) i systemy podgrzewające tytoń, implikuje konieczność weryfikacji dotychczasowego poradnictwa antynikotynowego realizowanego przez personel medyczny. Celem pracy było omówienie wpływu e-papierosów i podgrzewaczy tytoniu na realizację działań z zakresu minimalnej interwencji antynikotynowej (zasada 5P) przez lekarzy praktyków mających bezpośredni kontakt z pacjentem palącym w Polsce. Metody przeglądu: Publikacja ma charakter przeglądu narracyjnego. Do przeglądu piśmiennictwa użyto bazy PubMed/ Medline. W pracy przedstawiono rekomendacje dotyczące konieczności modyfikacji postępowania z pacjentem uzależnionym od nikotyny dostarczanej m.in. za pomocą e-papierosów i podgrzewaczy tytoniu w odniesieniu do dotychczas obowiązujący chstandardów minimalnej interwencji antytytoniowej, opartej na zasadzie 5P. Opis stanu wiedzy: E-papierosy i podgrzewacze tytoniu stanowią nową formę dostarczania nikotyny do organizmu. Nikotyna ma silny potencjał uzależniający. Aerozol z e-papierosa lub podgrzewacza tytoniu jest szkodliwy dla zdrowia. Użytkownik e-papierosa lub podgrzewacza tytoniu powinien być traktowany jak osoba uzależniona od nikotyny i objęty tymi samymi interwencjami antynikotynowymi co palacze papierosów. Podsumowanie: Szczególnie ważna w realizacji działań antynikotynowych jest właściwa identyfikacja osób uzależnionych od nikotyny, odnotowanie informacji na temat uzależnienia od nikotyny i sposobu przyjmowania nikotyny w dokumentacji medycznej pacjenta oraz zapewnienie mu podstawowego wsparcia behawioralnego oraz farmakoterapii wspierającej leczenie uzależnienia od nikotyny, niezależnie od tego, czy nikotyna przyjmowana jest w formie papierosa, e-papierosa czy podgrzewacza tytoniu.
... [13][14][15] Science-based risk comparisons show that the toxicity of vaping (inhaling nicotine through vaporizing systems, such as e-cigarettes) is markedly lower than inhaling cigarette smoke. 16 HTPs are mainly battery-powered devices that electronically heat tobacco sticks, which naturally contain nicotine, to ∼250-350 • C. 17 These sticks comprise tobacco (70%), as well as flavourings, glycerine and binding agents. 1,3 Like cigarettes, the aerosol released by HTPs contains harmful elements from pyrolysis and thermogenic degradation. ...
Article
Background Tobacco cigarettes, e-cigarettes and heated tobacco products can pose different health risks (harm continuum). As current tobacco smokers could benefit from switching to less harmful products, we aimed to assess current smokers’ perceived comparative health risks of these three products and to explore associations between risk perceptions and specific user characteristics. Methods We analysed data from 11 waves (2019–2021; N = 5657 current tobacco smokers) of a representative, cross-sectional household survey conducted in Germany. Associations were assessed with multivariable logistic regression models. Results 55.2% of smokers (95%CI = 53.8–56.5%) ranked cigarettes as the most harmful product. 36.1% of smokers (95%CI = 34.8–37.3%) perceived e-cigarettes and 33.8% (95%CI = 32.5–35.0%) heated tobacco products as more harmful than cigarettes. Misperceptions that e-cigarettes or heated tobacco products are more harmful to health than cigarettes increased over the 3-year study period and were more common among those with lower educational attainment. Conclusions Only half of current tobacco smokers in Germany perceive the comparative health risks of cigarettes adequately and such misperceptions have increased recently. As current smokers could benefit most from switching to less harmful products, educational campaigns are needed to inform this group about the health risks of tobacco smoking and the comparative health risks of the various nicotine and tobacco products along the harm continuum.
... In the last few years, several alternatives to smoking nicotine products have become available, which are commonly referred to as electronic nicotine delivery systems (ENDS), namely e-cigarettes and heated tobacco products (HTPs). While laboratory and limited clinical studies suggest that these products reduce exposure to toxins and may thus reduce health risks [8][9][10][11][12], very little is known about their epidemiological impact. ...
Article
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Background In the last few years, several nicotine products have become available as alternatives to smoking tobacco. While laboratory and limited clinical studies suggest that these devices are less toxic compared to classic tobacco cigarettes, very little is known about their epidemiological impact. Visiting the emergency department (ED) often represents the first or even the only contact of patients with the health care system. Therefore, a study conducted at the ED to assess the impact of these products on health can be reliable and reflect a real-life setting. Objective The aim of this noninterventional observational study (SMOPHED study) is to analyze the association between the severity of clinical presentation observed during ED visits among patients using various nicotine products and the subsequent outcomes, specifically hospitalization and mortality. Methods Outcomes (hospitalization and mortality in the ED) will be examined in relation to various patterns of nicotine products use. We plan to enroll approximately 2000 participants during triage at the ED. These individuals will be characterized based on their patterns of tobacco and nicotine consumption, identified through a specific questionnaire. This categorization will allow for a detailed analysis of how different usage patterns of nicotine products correlate with the clinical diagnosis made during the ED visits and the consequent outcomes. Results Enrollment into the study started in March 2024. We enrolled a total of 901 participants in 1 month (approximately 300 potential participants did not provide the informed consent to participate). The data will be analyzed by a statistician as soon as the database is completed. Full data will be published by December 2024. Conclusions There is substantial debate about the harm reduction potential of alternative nicotine products in terms of their smoking-cessation and risk-reduction potential. This study represents an opportunity to document epidemiological data on the link between the use of different types of nicotine products and disease diagnosis and severity during an ED visit, and thus evaluate the harm reduction potential claims for these products. International Registered Report Identifier (IRRID) PRR1-10.2196/54041
... With increasing public awareness of HTPs and the growing number of users, questions about the health effects of HTP use are increasing 2,9,10 . HTPs are being marketed as reduced exposure alternatives to combustible cigarettes 3,9,11 . ...
... www.nature.com/scientificreports/ it may expose users to less of some toxins that are also found in traditional cigarettes, the use of heated tobacco exposes users to other toxic substances whose toxicological profiles of short-and long-term health effects are unknown 2,3,9,10 . Nevertheless, HTP use may induce oxidative stress, and inflammation and increase the risk of respiratory tract infections 9,14 . ...
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Heated tobacco products (HTPs) are novel tobacco products that are alternatives to cigarettes. The study aimed to investigate the effect of HTPs on blood biomarkers of inflammation as well as to provide a comparative evaluation between daily heated tobacco users and healthy men who do not use nicotine products. This case–control study was carried out among 92 healthy males in Poland (Lodz-Province) aged 20–56 years: 44 daily heated tobacco users (daily use in the past 90 days) and 48 controls who do not use nicotine products. The history of use of the nicotine-containing products was self-reported and verified using a saliva cotinine test. A 20 ml blood sample was collected and the levels of ten blood biomarkers were analyzed. Among all heated tobacco users (n = 44), only the levels of interleukin 8 (IL-8) were significantly higher when compared to controls: 6.86 vs. 3.95 (p = 0.01). Among exclusive heated tobacco users (n = 33), the levels of IL-8 were also significantly higher when compared to controls: 7.76 vs. 3.95 (p = 0.01). IL-8 level was positively correlated (r = 0.37; p = 0.01) with the daily number of heated tobacco sticks. Out of 10 different biomarkers of inflammation, only IL-8 levels were significantly elevated in heated tobacco use compared to controls.
... Based on current knowledge, stating that vaping is at least 95 % less harmful than smoking remains a good way to communicate the large difference in relative risk unambiguously so that more smokers are encouraged to make the switch from smoking to vaping". Für den Bereich des erhitzten Tabaks finden sich ähnliche Einschätzungen, die beispielsweise von Mallock et al. (2019) zusammengefasst wurden. 12 Allcott and Rafkin (2022) befragten 137 Expertinnen und Experten. ...
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Zusammenfassung Neben der Umsatzsteuer unterliegt eine Reihe gesundheitsschädlicher Produkte einer spezifischen Verbrauchssteuer wie der Bier‑, Alkohol- und Tabaksteuer. In einer Gesamtschau dieser sin taxes offenbart sich ein Steuersystem voller Inkonsistenzen. Zum Beispiel unterliegt Bier einer speziellen Verbrauchssteuer, während der ebenfalls wegen seines Alkoholgehaltes gesundheitsschädliche Wein nicht spezifisch besteuert wird. Dieser Beitrag problematisiert die fehlende Systematik in der Besteuerung gesundheitsschädlicher Produkte. Diese Inkonsistenz rückt vor dem Hintergrund der aktuellen Diskussion um die Legalisierung von Cannabis besonders in den Fokus. Nach einer Bestandsaufnahme skizziert dieser Beitrag einen rationalen Besteuerungsansatz, der sich an den gesundheitlichen Risiken der Produkte orientiert. Dieser Ansatz identifiziert zwei mögliche Leitlinien der Besteuerung gesundheitsschädlicher Produkte: das jeweilige harm level des Produktes und die Preiselastizitäten.
... gas stations and convenience stores). 3 IQOS was introduced to the Canadian market in 2017 4 and is regulated under the Tobacco and Vaping Products Act. 5 Since HTPs heat rather than burn tobacco, levels of carcinogens and toxicants produced are lower than those emitted by cigarettes, 6 which contributed to the decision made by USA to approve IQOS as a "modified risk tobacco product." 7 However, an experimental study showed human bronchial cell cytotoxicity levels to be lower when using HTPs compared to when smoking cigarettes, but higher than during e-cigarette use. 2 Furthermore, a systematic review suggests a positive correlation between HTP use and the incidence of respiratory complications, including airway remodelling and inflammation. ...
Article
Introduction Heated tobacco products (HTPs) are novel tobacco products that may appeal to youth. This study explored whether HTP retailer proximity and density to secondary schools were associated with youth use of HTPs in four Canadian provinces. Methods An online search between November 2020 and March 2021 identified retailers selling IQOS devices and HEETS (tobacco sticks used in IQOS) within 500 m, 1000 m and 1500 m radius circular buffer zones around high schools (N = 120) participating in the COMPASS study in 2020–2021. Retailer proximity/density data were linked to crosssectional student-level data (N = 40 636 students), and multilevel regression models examined the association between HTP retailer proximity and density and current HTP use, controlling for relevant covariates. Results While only 10.0% of schools had at least one retailer selling IQOS devices within 1000 m of the school, 65.0% of schools had at least one retailer selling HEETS. The school a student attended accounted for 23.7% of the variability in the likelihood of currently using an HTP. However, HTP retailer proximity to and density around schools were not significantly associated with the likelihood of students currently using HTPs. Conclusion While the school a student attended accounted for a significant amount of variability in HTP use, these findings suggest that students may be obtaining HTPs through other, non-retail sources. Continued monitoring is warranted as HTP use among youth may change.
... While outside the scope of this review, we would also regard heated tobacco products in a similar way as a risk for introducing children and young people to nicotine. Current use in the UK and Europe is very rare, but we should be wary of the tobacco industry (which also funds this technology and most research carried out regarding the products) switching focus to marketing these products if vaping is more strongly regulated, without current good evidence of harm reduction compared with tobacco smoking [28,29]. Use and legal status of e-cigarettes E-cigarettes were initially promoted as an alternative to tobacco cigarettes to aid in smoking cessation, and this remains the main reason for support for the use of vaping products. ...
Article
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E-cigarettes are products delivering nicotine via inhalation and are devised to mimic tobacco smoking. While they were initially introduced as a device putatively to aid with smoking cessation, their use is now far broader than that. Use by children is significantly increasing. There is growing evidence of the potential harms of vaping. E-liquids used for e-cigarettes contain a wide range of harmful substances, and the clinical consequences of this are now being increasingly demonstrated, such as the rise in cases of e-cigarette- or vaping-associated lung injury. In addition, early use may result in long-term nicotine addiction. Vaping companies utilise marketing methods that distinctly target young people, and weak legislation in the UK allows them free rein to expose children to vaping. In this review we demonstrate why children must be protected from vaping. We must have stringent legislation to prevent easy access to e-cigarettes, including banning the convenience and affordability disposable vapes provide, and prevent marketing that does not warn about the potential health effects. The Australia approach of prescription or pharmacy only access for smoking cessation should be considered to limit exposure of children and minimise use by nonsmokers.
... Much of the recent tobacco harm reduction literature has focused on e-cigarette 1-3 and heated tobacco product (HTP) [3][4][5] use. However, nicotine pouches (NPs), aka modern oral nicotine pouches, comprising such prominent brands as ZYN and ON!, have recently been marketed as a cleaner form of nicotine delivery. ...
... At the same time, PMI can adjust relative product pricing and targeted promotions to encourage some smokers less inclined to using lower-risk NPs to switch to HTPs, which may lead to more regular use. [4][5][6] The impact of PMI's SM acquisition on industry transformation will also depend on how other firms react to PMI's business behavior. As the largest firm in many HICs and LMICs, PMI may act as a leader to other firms (Supplementary material, 40-42), particularly in protecting cigarette sales. ...
Article
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Introduction Sales data analyses are increasingly used to guide tobacco regulatory science. However, such data do not cover specialist retailers like vape shops or tobacconists. Understanding the extent of the cigarette and electronic nicotine delivery system (ENDS) markets covered by sales data is critical to establishing such analyses’ generalizability and potential biases. Methods Using retail sales data from Information Resources Incorporated (IRI) and Nielsen, we conduct tax gap analyses comparing states’ cigarette and ENDS tax revenue to tax collection estimates based on retail sales data. For the 23 US states in both retail sales datasets, cigarette tax gap analyses were conducted for each year from 2018-2020. Four (Louisiana, North Carolina, Ohio, and Washington) of those 23 states levied per unit ENDS taxes and provided monthly tax revenue data covering January 2018 - October 2021, where we conducted monthly tax gap analyses for both cigarettes and ENDS. Results Across states covered by both sales datasets, annual mean cigarette sales in IRI and Nielsen account for 92.3% (95% CI 88.3-96.2%) and 84.0% (95% CI 79.3-88.7%) of state cigarette tax revenue, respectively. Monthly average coverage rates for ENDS sales were lower, ranging from 42.3% to 86.1% for IRI and 43.6% to 88.5% for Nielsen, but remained stable over time. Conclusions IRI and Nielsen sales data capture almost the entire US cigarette market and a substantial but lower portion of the US ENDS market. With proper care to address shortcomings, sales data analyses can capture changes in the US market for these tobacco products. Implications Policy evaluations and analyses using e-cigarette and cigarette sales data are often criticized because these data do not cover online sales or sales by specialty retailers like tobacconists. Cigarette sales data consistently cover nearly 90% of taxed sales, while e-cigarette sales data cover around 50% of taxed volumes. Retail sales data capture nearly all cigarette sales and a substantial portion of ENDS sales with relatively stable rates of coverage over time, supporting their continued use in tobacco surveillance and policy evaluation work.
... In the last years several alternative to smoking nicotine products have become available, commonly called electronic nicotine delivery systems -ENDS), namely e-cigarettes and heated tobacco products. While laboratory and limited clinical studies suggest that these products reduce exposure to toxins and may thus reduce health risk [8][9][10][11][12], very little is still known about their epidemiological impact. ...
Preprint
BACKGROUND In the last years several alternative to smoking nicotine products have become available. While laboratory and limited clinical studies suggest that these devices are less toxic compared to classic tobacco cigarettes, very little is still known about their epidemiological impact. Visiting the Emergency Department (ED) often represents the first or the only contact of patients with the healthcare system, so a study conducted at ED to assess the impact of these products on health is reliable and reflects the real life. OBJECTIVE The primary endpoint of the study is to assess the association between the NEWS score and product use phenotypes. Our hypothesis is that use of ENDS may be associated with lower NEWS the score compared to cigarette smoking. If our hypothesis will be confirmed, the study will be replicated as a multicentre study in order to validate our findings. Secondary outcomes will be hospital admissions (vs. discharge) and length of stay in the ED. Moreover, we will compare the prevalence of acute diseases known to be smoking related between the two groups, specifically stroke, acute myocardial infarction (AMI), peripheral artery diseases (PAD) chronic obstructive pulmonary disease (COPD), asthma and respiratory infections. METHODS This is an observational study with no intervention or randomization, analysing the association between of the health condition during an ED visit as well as the outcome (hospitalization and death) and different patterns of nicotine products use. Specifically, it will explore relevant associations according to the smoking, e-cigarette use and heated tobacco product use status (current, former and never use). RESULTS The study will be an observational study, with no intervention or randomization, to analyse the association between severity of clinical presentation during an ED visit as well as the outcome (hospitalization and death) and different patterns of nicotine products use. Approximately 1500-2000 people will be enrolled and categorized according to different pattern of tobacco and nicotine consumption through a specific questionnaire. Patient recruitment will start by the end of 2023. Results will be reported within 2024. CONCLUSIONS There is a lot of debate about the harm reduction potential of alternative nicotine products in terms of their smoking-cessation and risk reduction potential. This study represents an opportunity to document epidemiological data on the link between different nicotine product use and disease diagnosis and severity during an ED visit, and thus evaluate the harm reduction potential claims for these products. CLINICALTRIAL n/a