The attractiveness and addictive potential of heated tobacco products: effects on perception and use and associated effects.

Decision FCTC/COP8(22) requests a report on several aspects of novel and emerging tobacco products, in particular heated tobacco products (HTPs). This paper addresses the aspect of addictive potential, perception and use, attractiveness, potential role in initiating and quitting smoking, marketing including promotional strategies and impacts, and claims of "reduced harm". We reviewed the attractive and addictive features of HTPs and the effects of those features on consumer perception and use. The available literature on HTPs was complemented by information from the wider body of knowledge on e-cigarettes. We searched the bibliographic database PubMed, with no restriction on time, up to January 2020. Studies on toxicity in users (i.e. toxicants in emissions, in-vitro studies, biomarkers of exposure) and environmental smoke and studies in a language other than English were excluded. We also included studies in the application of Philip Morris International (PMI) to the United States Food and Drug Administration (FDA) for their IQOS modified risk tobacco product (MRTP) were also used. With regard to features that increase attractiveness, information was found on sensory attributes, ease of use, cost, reputation and image, and assumed risks and benefit. Little is known about how these different features affect consumer perception and use; a recent study reported that six important factors were health, cost, enjoyment and satisfaction, ease of use, use practices and social aspects. With regard to addictiveness, currently marketed HTPs deliver significant levels of nicotine in aerosol, and their pharmacokinetics and physiological and subjective effects are similar to those of contemporary ENDS products, suggesting comparable abuse liability. HTPs have become popular in some markets, probably due to factors such as marketing as a "clean", modern, elegant, "reduced harm" product. Their sensory properties and ease of use are generally rated lower than those of conventional cigarettes but are directly correlated with their attractiveness, perceived risk and appeal, thus determining their uptake. The history of e-cigarettes shows that any new tobacco and related product that comes onto the market can quickly become popular. Knowledge of e-cigarettes indicates that the factors of concern for HTPs, and therefore potential regulatory targets, are nicotine levels and "throat hit", flavour variety, design of the device, marketing and perception of reduced harm. Common regulatory principles for e-cigarettes include minimizing product appeal and thus potential uptake by young people, increasing product safety and minimizing false beliefs about health effects. A similar strategy could be followed for HTPs. Policy-makers are advised to monitor the HTP market, communicate the risks to the general public, limit marketing, consider regulating flavours and stimulate research, especially on perceptions and use. [ABSTRACT FROM AUTHOR]