User login
Tobacco companies are marketing a new version of cigarettes dubbed heat-not-burn (HNB) cigarettes.1,2 Offered as a “modified-risk tobacco product,” HNB cigarettes utilize a lithium battery-powered heating element and are available all over the world.1,2 Like conventional smokes, they contain tobacco, but deliver nicotine by heating leaves at 350° C rather than burning them at 600° C.1-3 Heating the tobacco produces an inhalable aerosol with tobacco flavor and nicotine, without smoke. These HNB cigarettes are also different from e-cigarettes that aerosolize a liquid.
Tobacco companies contend that HNB cigarettes are safer than smoking tobacco.1 Consumers inhale a heated tobacco aerosol that reportedly contains less nicotine and fewer toxicities; yet, HNB are not independently substantiated as being healthier, nor proven safe.1-5 Thermal decomposition, rather than combustion, may afford a less dangerous nicotine consumption; however, HNB aerosols deliver many of the same dangerous compounds as traditional cigarettes, including carbon monoxide, tar, and aromatic hydrocarbons.2-6 Despite possible harm reduction in the short-run, long-term safety remains unconfirmed.
Safety in passive environmental inhalations is not established.2 HNB cigarettes are contraindicated during pregnancy and/or lactation. Nicotine is provided in addictive quantities, enough to foster continued dependence. Exposure to HNB products can promote longer-term usage or lead to smoking traditional tobacco cigarettes. There is also an increased risk to non-smokers of exposure to HNB aerosols. Additionally, lithium batteries have been known to burn or explode. HNB devices may even lead to privacy concerns due micro-controller chips contained within that harvest information. These chips could inform manufacturers about device usage.7
Tobacco is a global health hazard and smoking is the number one preventable cause of disease.1,5,8 Global smoking prevalence is nearing 19%.9 There are concerns about dual use, rather than HNB cigarettes alone as a substitute for conventional smoking. The ultimate hope is to abstain from all tobacco and nicotine. Although HNB inhalations contain fewer toxic chemicals than by smoking, evidence regarding mitigation of tobacco-related diseases is inconclusive.10
Physicians have an obligation to minimize tobacco and nicotine-related hazards. Ongoing research and clinical exposure might better document the health impact of HNB cigarettes. Until the risks and benefits of HNB cigarettes are confirmed, health care professionals would be wise to counsel against their use.
Diksha Mohanty, MD; Steven Lippmann, MD
Louisville, Ky
1. Combustible cigarettes kill millions a year. Can Big Tobacco save them? The Economist Web site. https://www.economist.com/business/2017/12/19/combustible-cigarettes-kill-millions-a-year-can-big-tobacco-save-them. Accessed November 9, 2018.
2. Auer R, Concha-Lozano N, Jacot-Sadowski I, et al. Heat-not-burn tobacco cigarettes: smoke by any other name. JAMA Intern Med. 2017;177:1050-1052.
3. Caputi TL. Industry watch: heat-not-burn tobacco products are about to reach their boiling point. Tob Control. 2016;26:609-610.
4. Jenssen BP, Walley SC, McGrath-Morrow SA. Heat-not-burn tobacco products: Tobacco industry claims no substitute for science. Pediatrics. 2018;141:e20172383.
5. Levy DT, Cummings KM, Villanti AC, et al. A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction. 2017;112:8-17.
6. Bekki K, Inaba Y, Uchiyama S, et al. Comparison of chemicals in mainstream smoke in heat-not-burn tobacco and combustion cigarettes. J UOEH, 2017;39:201-207.
7. Lasseter T, Wilson D, Wilson T, et al. Philip Morris device knows a lot about your smoking habit. Reuters. https://www.reuters.com/investigates/special-report/tobacco-iqos-device. Accessed November 9, 2018.
8. Carter BD, Abnet CC, Feskanich D, et al. Smoking and mortality — beyond established causes. New Engl J Med. 2015;372:631-640.
9. World Health Organization. WHO global report on trends in tobacco smoking 2000-2025 - First edition. http://www.who.int/tobacco/publications/surveillance/reportontrendstobaccosmoking/en/index4.html. Accessed November 9, 2018.
10. U.S. Food & Drug Administration. CTPConnect—September 2017. https://www.fda.gov/TobaccoProducts/NewsEvents/ucm576895.htm. Updated June 14, 2018. Accessed Nov ember 9, 2018.
Tobacco companies are marketing a new version of cigarettes dubbed heat-not-burn (HNB) cigarettes.1,2 Offered as a “modified-risk tobacco product,” HNB cigarettes utilize a lithium battery-powered heating element and are available all over the world.1,2 Like conventional smokes, they contain tobacco, but deliver nicotine by heating leaves at 350° C rather than burning them at 600° C.1-3 Heating the tobacco produces an inhalable aerosol with tobacco flavor and nicotine, without smoke. These HNB cigarettes are also different from e-cigarettes that aerosolize a liquid.
Tobacco companies contend that HNB cigarettes are safer than smoking tobacco.1 Consumers inhale a heated tobacco aerosol that reportedly contains less nicotine and fewer toxicities; yet, HNB are not independently substantiated as being healthier, nor proven safe.1-5 Thermal decomposition, rather than combustion, may afford a less dangerous nicotine consumption; however, HNB aerosols deliver many of the same dangerous compounds as traditional cigarettes, including carbon monoxide, tar, and aromatic hydrocarbons.2-6 Despite possible harm reduction in the short-run, long-term safety remains unconfirmed.
Safety in passive environmental inhalations is not established.2 HNB cigarettes are contraindicated during pregnancy and/or lactation. Nicotine is provided in addictive quantities, enough to foster continued dependence. Exposure to HNB products can promote longer-term usage or lead to smoking traditional tobacco cigarettes. There is also an increased risk to non-smokers of exposure to HNB aerosols. Additionally, lithium batteries have been known to burn or explode. HNB devices may even lead to privacy concerns due micro-controller chips contained within that harvest information. These chips could inform manufacturers about device usage.7
Tobacco is a global health hazard and smoking is the number one preventable cause of disease.1,5,8 Global smoking prevalence is nearing 19%.9 There are concerns about dual use, rather than HNB cigarettes alone as a substitute for conventional smoking. The ultimate hope is to abstain from all tobacco and nicotine. Although HNB inhalations contain fewer toxic chemicals than by smoking, evidence regarding mitigation of tobacco-related diseases is inconclusive.10
Physicians have an obligation to minimize tobacco and nicotine-related hazards. Ongoing research and clinical exposure might better document the health impact of HNB cigarettes. Until the risks and benefits of HNB cigarettes are confirmed, health care professionals would be wise to counsel against their use.
Diksha Mohanty, MD; Steven Lippmann, MD
Louisville, Ky
Tobacco companies are marketing a new version of cigarettes dubbed heat-not-burn (HNB) cigarettes.1,2 Offered as a “modified-risk tobacco product,” HNB cigarettes utilize a lithium battery-powered heating element and are available all over the world.1,2 Like conventional smokes, they contain tobacco, but deliver nicotine by heating leaves at 350° C rather than burning them at 600° C.1-3 Heating the tobacco produces an inhalable aerosol with tobacco flavor and nicotine, without smoke. These HNB cigarettes are also different from e-cigarettes that aerosolize a liquid.
Tobacco companies contend that HNB cigarettes are safer than smoking tobacco.1 Consumers inhale a heated tobacco aerosol that reportedly contains less nicotine and fewer toxicities; yet, HNB are not independently substantiated as being healthier, nor proven safe.1-5 Thermal decomposition, rather than combustion, may afford a less dangerous nicotine consumption; however, HNB aerosols deliver many of the same dangerous compounds as traditional cigarettes, including carbon monoxide, tar, and aromatic hydrocarbons.2-6 Despite possible harm reduction in the short-run, long-term safety remains unconfirmed.
Safety in passive environmental inhalations is not established.2 HNB cigarettes are contraindicated during pregnancy and/or lactation. Nicotine is provided in addictive quantities, enough to foster continued dependence. Exposure to HNB products can promote longer-term usage or lead to smoking traditional tobacco cigarettes. There is also an increased risk to non-smokers of exposure to HNB aerosols. Additionally, lithium batteries have been known to burn or explode. HNB devices may even lead to privacy concerns due micro-controller chips contained within that harvest information. These chips could inform manufacturers about device usage.7
Tobacco is a global health hazard and smoking is the number one preventable cause of disease.1,5,8 Global smoking prevalence is nearing 19%.9 There are concerns about dual use, rather than HNB cigarettes alone as a substitute for conventional smoking. The ultimate hope is to abstain from all tobacco and nicotine. Although HNB inhalations contain fewer toxic chemicals than by smoking, evidence regarding mitigation of tobacco-related diseases is inconclusive.10
Physicians have an obligation to minimize tobacco and nicotine-related hazards. Ongoing research and clinical exposure might better document the health impact of HNB cigarettes. Until the risks and benefits of HNB cigarettes are confirmed, health care professionals would be wise to counsel against their use.
Diksha Mohanty, MD; Steven Lippmann, MD
Louisville, Ky
1. Combustible cigarettes kill millions a year. Can Big Tobacco save them? The Economist Web site. https://www.economist.com/business/2017/12/19/combustible-cigarettes-kill-millions-a-year-can-big-tobacco-save-them. Accessed November 9, 2018.
2. Auer R, Concha-Lozano N, Jacot-Sadowski I, et al. Heat-not-burn tobacco cigarettes: smoke by any other name. JAMA Intern Med. 2017;177:1050-1052.
3. Caputi TL. Industry watch: heat-not-burn tobacco products are about to reach their boiling point. Tob Control. 2016;26:609-610.
4. Jenssen BP, Walley SC, McGrath-Morrow SA. Heat-not-burn tobacco products: Tobacco industry claims no substitute for science. Pediatrics. 2018;141:e20172383.
5. Levy DT, Cummings KM, Villanti AC, et al. A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction. 2017;112:8-17.
6. Bekki K, Inaba Y, Uchiyama S, et al. Comparison of chemicals in mainstream smoke in heat-not-burn tobacco and combustion cigarettes. J UOEH, 2017;39:201-207.
7. Lasseter T, Wilson D, Wilson T, et al. Philip Morris device knows a lot about your smoking habit. Reuters. https://www.reuters.com/investigates/special-report/tobacco-iqos-device. Accessed November 9, 2018.
8. Carter BD, Abnet CC, Feskanich D, et al. Smoking and mortality — beyond established causes. New Engl J Med. 2015;372:631-640.
9. World Health Organization. WHO global report on trends in tobacco smoking 2000-2025 - First edition. http://www.who.int/tobacco/publications/surveillance/reportontrendstobaccosmoking/en/index4.html. Accessed November 9, 2018.
10. U.S. Food & Drug Administration. CTPConnect—September 2017. https://www.fda.gov/TobaccoProducts/NewsEvents/ucm576895.htm. Updated June 14, 2018. Accessed Nov ember 9, 2018.
1. Combustible cigarettes kill millions a year. Can Big Tobacco save them? The Economist Web site. https://www.economist.com/business/2017/12/19/combustible-cigarettes-kill-millions-a-year-can-big-tobacco-save-them. Accessed November 9, 2018.
2. Auer R, Concha-Lozano N, Jacot-Sadowski I, et al. Heat-not-burn tobacco cigarettes: smoke by any other name. JAMA Intern Med. 2017;177:1050-1052.
3. Caputi TL. Industry watch: heat-not-burn tobacco products are about to reach their boiling point. Tob Control. 2016;26:609-610.
4. Jenssen BP, Walley SC, McGrath-Morrow SA. Heat-not-burn tobacco products: Tobacco industry claims no substitute for science. Pediatrics. 2018;141:e20172383.
5. Levy DT, Cummings KM, Villanti AC, et al. A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products. Addiction. 2017;112:8-17.
6. Bekki K, Inaba Y, Uchiyama S, et al. Comparison of chemicals in mainstream smoke in heat-not-burn tobacco and combustion cigarettes. J UOEH, 2017;39:201-207.
7. Lasseter T, Wilson D, Wilson T, et al. Philip Morris device knows a lot about your smoking habit. Reuters. https://www.reuters.com/investigates/special-report/tobacco-iqos-device. Accessed November 9, 2018.
8. Carter BD, Abnet CC, Feskanich D, et al. Smoking and mortality — beyond established causes. New Engl J Med. 2015;372:631-640.
9. World Health Organization. WHO global report on trends in tobacco smoking 2000-2025 - First edition. http://www.who.int/tobacco/publications/surveillance/reportontrendstobaccosmoking/en/index4.html. Accessed November 9, 2018.
10. U.S. Food & Drug Administration. CTPConnect—September 2017. https://www.fda.gov/TobaccoProducts/NewsEvents/ucm576895.htm. Updated June 14, 2018. Accessed Nov ember 9, 2018.