A Scoping Review of Behavioural Studies on Heated Tobacco Products.

Heated tobacco products (HTPs) are electronic devices that heat tobacco sticks to temperatures much lower than those which cause pyrolysis and combustion in cigarettes. While this electrical heating causes the formation of an inhalable aerosol which contains nicotine, the aerosol from HTPs contains significantly fewer and lower levels of the harmful and potentially harmful chemicals found in cigarette smoke. As a result, HTP use potentially conveys reduced risks to health compared to cigarette smoking. While this relative reduction in individual health risk is becoming clearer, what is less certain is the impact of HTPs on overall population‑level health, taking into account both the potential positive impact on adult smokers who completely switch to using HTPs and any unintended impacts such as use by tobacco non‑users and particularly by youth. The aim of this scoping review was to collate and evaluate the published scientific evidence to date, with a cut‑off of 1 January 2024, investigating the impact of HTPs on population‑level health. This evaluation suggests that HTP use is almost exclusively observed among those with a history of cigarette smoking, and there is a growing body of evidence for the ability of HTPs to provide support for adult smokers to transition away from cigarette smoking, in the absence of any significant "gateway" into tobacco use initiation. Many studies have reported a significant degree of dual use of cigarettes and HTPs, and efforts to assess the reasons for such patterns of use, whether these provide overall exposure reductions, and whether dual use acts as a bridge towards a complete transition away from cigarette smoking, requires further investigation. In addition, correction of the widespread and increasing misperceptions of HTPs among adult smokers is recommended to promote HTP uptake as a potentially less harmful alternative to smoking in this population.
Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This writing of this review was funded by Imperial Brands PLC, a manufacturer of tobacco and nicotine products including heated tobacco products. Financial relationships: Ian M. Fearon declare(s) personal fees from Imperial Brands PLC. Ian M. Fearon declare(s) personal fees from LA Clinical Trials, LLC. Ian M. Fearon declare(s) personal fees from Cheerain HK Ltd. Ian M. Fearon declare(s) personal fees and stock/stock options from British American Tobacco. Ian M. Fearon declare(s) personal fees from RAI Services Company. Ian M. Fearon declare(s) personal fees from Shenzhen Smoore Technology, Ltd. Ian M. Fearon declare(s) personal fees from Advanced Inhalation Rituals, Ltd. Ian M. Fearon is a Non-Executive Director with Advanced Inhalation Rituals, Ltd., a manufacturer of waterpipe tobacco and electronic waterpipe products. Ian M. Fearon declare(s) personal fees and stock/stock options from Qnovia, LLC. Ian M. Fearon is a consultant to, and Scientific Advisory Board Member of, Qnovia, LLC, an inhaled nicotine pharmaceutical smoking cessation product manufacturer. Thomas Nahde declare(s) employment and stock/stock options from Reemtsma Cigarettenfabriken GmbH. Employed by Reemtsma Cigarettenfabriken GmbH, an Imperial Brands PLC company. Sarah F. Cordery, Martin Fitzpatrick, Sarah Weaver, Matthew Stevenson, Erika Grandolfo, and Layla Malt declare(s) employment and stock/stock options from Imperial Brands PLC. Ian M. Fearon declare(s) personal fees from Tobacco and nicotine product manufacturers and CROs. Ian M. Fearon is an independent consultant to tobacco and nicotine product manufacturers, and CROs, and provides scientific support for clinical and behavioural studies and general regulatory support. These manufacturers/CROs are unspecified for confidentiality reasons. Ian M. Fearon declare(s) employment from Broughton Life Sciences, Ltd. Ian M. Fearon declare(s) personal fees from E-Alternative Solutions, LLC. Ian M. Fearon declare(s) personal fees from Shenzhen JWEI Electronics Co., Ltd. Ian M. Fearon declare(s) personal fees from JUUL Labs and JUUL Labs UK Holdco, Ltd. Ian M. Fearon declare(s) employment from McKinney Regulatory Science Advisors, LLC. Ian M. Fearon declare(s) Travel expenses from Messe Dortmund GmbH. To attend and present at a tobacco expo. Keith Thompson declare(s) employment from Elucid8 Holdings Ltd. Employed by Elucid8 Holdings Ltd. and is acting as an independent scientific consultant to Imperial Brands PLC. Keith Thompson is a former employee of Gallaher Ltd. and Japan Tobacco International UK Ltd. Imperial Brands and Japan Tobacco International produce the electrically heated tobacco products ‘Pulze’ and ‘Ploom’, respectively. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
(Copyright © 2024, Fearon et al.)