Study estimates the scale and growth potential of heat-not-burn cigarettes

In 2014, a new type of tobacco product, a heat-not-burn cigarette, was marketed to the people of Japan. These battery-powered cigarettes heat tobacco to roughly 500 degrees Fahrenheit, releasing an ashless, smokeless aerosol that contains nicotine.

According to a new study that used Google search query data to estimate the scale and growth potential of heat-not-burn tobacco products, interest in heat-not-burn cigarettes is already growing faster in Japan than it did for e-cigarettes when they first emerged on the market.

"Two years ago, there were essentially no queries in Japan for heat-not-burn tobacco, but now there are between 5.9 and 7.5​ ​million​ ​each​ ​month," said study co-author Mark Dredze, PhD, in a press release.

These findings suggest the popularity of heat-not-burn cigarettes could quickly eclipse that of e-cigarettes if they're introduced to markets in other countries. Yet, relatively little is known about heat-not burn cigarettes or their safety.

"In the entire ​PubMed database—which catalogues millions of public health studies—just 26 studies even mention heat-not-burn tobacco," said ​study co-author Eric Leas, PhD, a postdoctoral researcher at the Stanford Prevention Research Center in the press release. "There is​ ​a​ ​tremendous​ ​amount​ ​we​ ​need​ ​to​ ​learn​ ​about​ ​heat-not-burn​ ​tobacco."

I corresponded with Leas to learn more about the study and its implications for Phillip Morris' heat-not-burn product, called iQOS, which is under review with the FDA for marketing and distribution and may soon be introduced in the U.S..

What is the main appeal of heat-not-burn cigarettes?

The main appeal of heat-not-burn cigarettes is the delivery of the “throat-hit” of combustible cigarettes without the combustion. This type of hit is not achieved by most e-cigarette and vaping devices.

Why do you think heat-not-burn cigarettes have the potential to be popular in the U.S.?

Heat-not-burn products are taking off in markets they've been introduced into around the world [and] there is also clearly a demand for "safer" tobacco products in the United States. This has been seen mainly in the major growth in e-cigarette use over the last 5 years, but is also seen even among cigarette brands. For instance, in a recent report we showed that more than 2.5 million U.S. smokers use a brand of cigarettes that they believe might be "less harmful."

The FDA's new plan for tobacco and nicotine regulation aims to reduce nicotine in combustible cigarettes, while giving newly regulated combustible and non-combustible tobacco products extended deadlines to apply for review. How might this affect the review process for heat-not-burn cigarettes?

It's too early for me to know what impact, if any, that new plan will have on heat-not-burn products. What I do know is that PMI [Phillip Morris International] is going through the "modified risk tobacco product" permitting process, which is different than the premarket process for other tobacco products. In this process, the manufacturer attempts to provide evidence that their product has reduced health risks compared to similar types of tobacco products on the market. Upon completion the manufacturer can make claims of reduce-harm in their marketing.

In your paper, you and your co-authors recommend "traditional surveillance strategies" to monitor heat-not-burn markets. What would this would entail?

Adding questions about heat-not-burn cigarettes to surveys to understand use and perceptions of these products among the general population. For instance, these items could be added to the Behavioral Risk Factor Surveillance System [a nationwide health-related telephone survey system that collects data from U.S. residents regarding their health-related risk behaviors, chronic health conditions and use of preventive service] which is run by the U.S. Center for Disease Control and Prevention.

Your team's previous ​studies of e-cigarettes first​​ ​predicted​ ​the​ ​rise​ ​of​ ​actual​ ​vaping​ ​rates. You've just applied this technique to heat-not-burn cigarettes with the aim to predict their popularity. What's next for you and your team?

We hope our understanding of these data can help shape policy and practice in near-real-time. Some of our recent published work has focused on understanding reactions to popular TV shows, (e.g., "13 Reasons Why"), celebrity effects, (e.g., Charlie Sheen and Leonardo DiCaprio), and introduction of new video games, (e.g., Pokémon Go).

[We] are always on the lookout for new applications.

Previously: Researchers explore effects of “environmentally friendly” cigarette ad campaign, False advertising? “Natural” cigarettes are bad for nature, Stanford researchers say, and Misperceptions of smoking risk abound, Stanford research shows
Photo by SimonDes

Theodore L. Caputi
Theodore L. Caputi
Economics & Health Researcher

My research interests include public health, health innovation, and health care.