Heated Tobacco Products: What They Are and What We Know About Their Risks

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Heated tobacco products heat processed tobacco leaf so the user inhales nicotine into the lungs. Brands allowed on sale in the United States include IQOS and Eclipse.

The bottom line

Their short- and long-term health effects need more research.
Using any tobacco product, heated tobacco included, is harmful, especially for young people, young adults, pregnant women and adults who don't already use tobacco.
They have not been shown to help smokers quit, and are not an FDA-approved way to quit.
If you have never used tobacco, don't start.

A simple drawing of an electronic heated tobacco device: a charger case, a holder and a tobacco stick

An electronically heated tobacco product. CDC.

What they are

Often marketed as "heat-not-burn" products, they come in several forms:

Electronic devices that heat sticks, plugs or capsules of tobacco (the electronic kind authorised for sale in the U.S. works this way); others heat a liquid whose vapour passes through tobacco to pick up flavour and nicotine, or heat loose tobacco, sometimes with cannabis flower, in a sealed chamber. Some use flavourings, and some let users set the temperature.
Cigarette-like sticks with a carbon tip wrapped in glass fibre, lit with a lighter or match. Federal law allows these to be sold.

They are not e-cigarettes. Heated tobacco products heat actual tobacco leaf; e-cigarettes heat a liquid usually containing nicotine taken from tobacco, plus flavourings and other ingredients.

Health effects

They are still new in the U.S., and scientists are still learning. Whether heated by flame or electronically, they contain nicotine, which is highly addictive; can harm the developing adolescent brain, which keeps developing to about age 25, affecting attention, learning, mood and impulse control and possibly raising the risk of other addictions; and is toxic to a developing fetus.

Secondhand emissions are not as safe as clean air: studies suggest they expose users and bystanders to some of the same chemicals as cigarette smoke, though at lower levels.

Less harmful than cigarettes?

Their emissions generally contain lower levels of harmful ingredients than cigarette smoke, but that doesn't make them safe: they contain many of the same harmful ingredients and some that cigarettes don't. Whether smokers who switch completely lower their disease risk is unknown. Studies abroad suggest most adult users haven't quit cigarettes, U.S. surveys suggest young adults use them alongside other tobacco, and using several tobacco products is linked to greater nicotine dependence and harm.

As of February 2022, the FDA had authorised only one heated tobacco system, IQOS and three of its Heatstick products, to be marketed as modified risk tobacco products, the first to receive "exposure modification" orders. They may be marketed as reducing exposure to harmful chemicals for smokers who switch completely, but not as reducing disease risk, as FDA-endorsed, or as safe; no such claims may be made for other products or for secondhand exposure.

Who uses them

CDC began tracking adult use in 2017, when 0.7% of adults, and 2.7% of current smokers, had ever tried one.
In 2018 that rose to 2.4% of adults and 6.7% of current smokers.
A 2019 survey found e-cigarette users were more likely than cigarette smokers to have tried one.
In 2023, 1.0% of U.S. middle and high school students had used one in the past 30 days.
Sales of other heated tobacco products are growing worldwide.

What people can do

States, communities, tribes and territories can include heated tobacco in smoke-free and tobacco-free policies; license tobacco retailers, limit young people's access in stores and penalise sales to minors; raise prices; limit flavoured products; curb marketing that appeals to young people; and educate about the risks.

Parents and teachers can learn about the products, set an example with a tobacco-free home, talk with young people about why all tobacco is harmful, and enforce tobacco-free school policies and prevention programmes free of tobacco industry influence.

Health professionals can ask about all forms of tobacco when screening, talk with young patients about the harms, and help patients quit with support and proven treatments.