Exposure to Heated Tobacco Products and Adverse Health Effects, a Systematic Review.

Heated tobacco products (HTP) are a form of nicotine delivery intended to be an alternative to traditional cigarettes. HTP tobacco products are sold to consumers as a less harmful alternative to traditional cigarettes, both for users and bystanders. The actual impact of HTP on the health of users and its overall impact on public health is still not fully known. A systematic search of the literature was carried out to identify relevant studies published in English from 2015 to February 2021. The following databases were used: PubMed, Scopus, Elsevier and ClinicalKey. 25 studies (independent and sponsored by the tobacco industry) were considered. The analysis of exposure biomarkers and cardiovascular and respiratory biomarkers showed differences between smokers and people using heated tobacco products. Improvements in clinically relevant risk markers, especially cholesterol, sICAM-1, 8-epi-PGF2α, 11-DTX-B2, HDL and FEV1, were observed compared to persistent cigarette smokers. On the other hand, exposure to IQOS has been reported to alter mitochondrial function, which may further exaggerate airway inflammation, airway remodeling and lung cancer. These products have the potential to increase oxidative stress and increase respiratory tract infections by increasing microbial adherence to the respiratory tract. Our review suggests that HTP products may be products with a reduced risk of chronic diseases, including respiratory and cardiovascular diseases and cancer compared to traditional smoking, although in the case of non-smokers so far, they may pose a risk of their occurrence. Research seems to be necessary to assess the frequency of HTP use and its potential negative health effects.

Awareness and use of electronic cigarettes and heat-not-burn tobacco products in Japan.

BACKGROUND AND AIMS: In addition to some electronic cigarettes (e-cigarettes), new heat-not-burn tobacco products Ploom and iQOS have recently begun to be sold by tobacco companies. These products are regulated differently in Japan, depending on whether the contents are liquid or tobacco leaf. Our objective was to estimate percentages of awareness and use of e-cigarettes and heat-not-burn tobacco products among the Japanese population, including minors. DESIGN AND SETTING: An internet survey (randomly sampled research agency panellists) with a propensity score adjustment for "being a respondent in an internet survey" using a nationally representative sample in Japan. PARTICIPANTS: A total of 8240 respondents aged 15-69 years in 2015 (4084 men and 4156 women). MEASUREMENTS: Adjusted percentages of awareness and use of e-cigarettes (nicotine or non-nicotine e-cigarettes) and heat-not-burn products among total participants; product types and percentages ever used among e-cigarettes ever users. FINDINGS: Of respondents in Japan, 48% [95% confidence interval (CI) = 47-49] were aware of e-cigarettes and heat-not-burn tobacco products, 6.6% (95% CI = 6.1-7.1) had ever used, 1.3% (95% CI = 1.0-1.5) had used in the last 30 days and 1.3% (95% CI = 1.1-1.6) had experience of > 50 sessions. Seventy-two per cent (95% CI = 69-76) of ever users used non-nicotine e-cigarettes, while 33% (95% CI = 30-37) of them used nicotine e-cigarettes, which has the majority share world-wide; 7.8% (95% CI = 5.5-10.0) and 8.4% (95% CI = 6.1-10.7) of them used the new devices, Ploom and iQOS, respectively, with a relatively higher percentage among the younger population. CONCLUSIONS: Approximately half the respondents in a Japanese internet survey were aware of e-cigarettes and heat-not-burn tobacco products, 6.6% had ever used. More than 70% of ever users used non-nicotine e-cigarettes, the sale of which is not legally prohibited, even to minors, in Japan, and 33% of them used nicotine e-cigarettes; 3.5% of never smoking men and 1.3% of never smoking women had ever used e-cigarettes. Corresponding figures for use in the last 30 days were 0.6% and 0.3%, predominantly non-nicotine e-cigarettes.