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Background/objectives: Smoking increases the risk for multiple lifestyle-related diseases. In Japan, consumption of heated tobacco products (HTPs), a novel cigarette type, is rising. However, no studies have yet compared dietary habits among HTP smokers. This study assessed food and nutrient intake and alcohol consumption by smoking status (non-smokers, cigarette smokers, HTP smokers). Methods: This cross-sectional study included 237 HTP smokers, 242 cigarette smokers, and 178 non-smokers (50% each male and female). The Brief Self-Administered Diet History Questionnaire was administered as a nutritional survey, and smokers were asked about their smoking status, including smoking history and the number of puffs smoked per day. Results: A significantly higher intake of meat was seen in HTP smokers than in cigarette smokers (p = 0.038), and HTP smokers showed the lowest intake of vitamin D in all groups. HTP and cigarette smokers had a lower intake of certain vitamins, minerals, and dietary fiber compared with non-smokers. The rate of habitual drinkers (at least one drink a month) and their alcohol consumption (g/day) were significantly lower in non-smokers (58%, 1.3 g) than in HTP smokers (67%, 4.8 g) and cigarette smokers (70%, 7.1 g) (p = 0.031). Additionally, after adjusting for sex and smoking status in a multiple regression analysis, the number of puffs was a significant contributor to alcohol intake in HTP smokers (β = 0.296, p < 0.001). Conclusions: This study identified significant dietary, nutritional, and alcohol consumption differences based on smoking status, underscoring the need to consider both diet and smoking type in nutritional counseling and smoking cessation guidance. [ABSTRACT FROM AUTHOR]

The heated tobacco product (HTP) heats rather than burns tobacco to release an aerosol with significantly fewer toxicants than conventional cigarette smoke and has received global attention in recent years. To investigate whether changes in biomarkers of exposure could be detected after switching from conventional cigarettes (CCs) to HTPs, 224 subjects from four cities in China participated in this study. Nine biomarkers containing tobacco-specific nitrosamines (TSNAs), volatile organic compounds (VOCs), and the biomarkers for acrolein and crotonaldehyde were determined by UPLC-MS/MS. The levels of the sum of nine biomarkers in CCs were 5.4 and 5.2 times higher than in an Original-HTP and Menthol-HTP, respectively. Among the nine biomarkers, 3HPMA and 3HMPMA accounted for the highest proportions. Switching from CCs to HTPs is good for both men and women because the changes in each biomarker in urine samples were the same in men and women. Among all the subjects, subjects aged 20–39 years had the greatest reduction in biomarker residues in urine. The findings of the present study provided useful information for the health risk research of HTPs in China. [ABSTRACT FROM AUTHOR]

In addition to the market launch of heated tobacco products (HTPs) and the JUUL as well as the EVALI, they caused a widespread discussion on the risk reduction compared to a combustible cigarette. Furthermore, first data showed harmful effects on the cardiovascular system. We, therefore, conducted investigations including a control group with a nicotine-free liquid. Forty active smokers were studied in two different approaches during and after consuming an HTP, a cigarette, a JUUL, or a typical electronic cigarette with or without nicotine in a partly double-blinded randomised, cross-over trial. Inflammation, endothelial dysfunction, and blood samples (full blood count, ELISA, multiplex immunoassay) were analysed, and arterial stiffness was measured. In addition to the cigarette, an increase in the white blood cell count but also in proinflammatory cytokines was shown for the various nicotine delivery systems. These correlated with the parameters of arterial vascular stiffness as a clinical parameter of endothelial dysfunction. It can be shown that even a single consumption of the different nicotine delivery system or cigarette leads to a significant inflammatory reaction followed by endothelial dysfunction and increased arterial stiffness causing cardiovascular disease. Inflammation, endothelial dysfunction, and arterial stiffness should be addressed in long-term observational studies. [ABSTRACT FROM AUTHOR]

Many different nicotine delivery products, such as e-cigarettes (e-cigs) or heated tobacco products (HTPs), are available on the market. To better understand these products, it is crucial to learn how consumers use them and how much nicotine they deliver. Therefore, a pod e-cig, an HTP, and a conventional cigarette (CC) were each used by 15 experienced users of the respective product category for 90 min without special use instructions ("ad libitum"). Sessions were video recorded to analyze usage patterns and puff topography. At defined time points, blood was sampled to determine nicotine concentrations, and subjective effects were inquired about using questionnaires. During the study period, the CC and HTP groups averaged the same number of consumption units (both 4.2 units). In the pod e-cig group, the highest number of puffs was taken (pod e-cig 71.9; HTP: 52.2; CC: 42.3 puffs) with the most extended mean puff duration (pod e-cig: 2.8 s; HTP: 1.9 s; CC: 1.8 s). Pod e-cigs were predominantly used with single puffs or in short clusters of 2–5 puffs. The maximum plasma nicotine concentration was highest for CCs, followed by HTPs, and then pod e-cigs with 24.0, 17.7, and 8.0 ng/mL, respectively. Craving was reduced by all products. The results suggest that the high nicotine delivery known for tobacco-containing products (CCs and HTPs) may not be needed for non-tobacco-containing products (pod e-cigs) to satisfy cravings in experienced users. [ABSTRACT FROM AUTHOR]

In the present study, we evaluated the acute response of mice exposed to IQOS aerosol, a brand-name heated tobacco product (HTP), in the lung tissue. First, the thiobarbituric acid-reactive substances (TBA-RS) value was measured as an index to assess oxidative stress, and a significant increase was observed after exposure, followed by a significant increase in the total lung GSH concentration. The stress responses induced by IQOS aerosols was then analyzed by focusing on the changes in Nrf2 and ATF4, which are transcription factors that induce the expression of genes involved in GSH biosynthesis or metabolism. Although Nrf2 activation was not observed, significant accumulation of ATF4 in the nuclear fraction was noted three hours after exposure to IQOS aerosols. Upon an examination of changes in factors in the GSH biosynthetic system, a significant increase in cystine concentration in the lung tissue was measured, and an increase in xCT expression level was observed in the cell membrane fraction three–six hours after IQOS exposure. Furthermore, characteristic changes in HO-1, a stress-response protein regulated by ATF4, was discovered six hours after IQOS exposure. Moreover, analysis of the upstream ATF4 regulatory system revealed that phosphorylation of eIF2α was enhanced in the lung cytoplasmic fraction three hours after exposure to IQOS aerosols. These findings suggest that ER stress might be induced as an early response to IQOS aerosol exposure, accompanied by the activation of the eIF2α-ATF4 axis. These intracellular changes have also been reported after exposure to combustible cigarette smoke. Thus, the acute response found in the lungs of mice in the present study demonstrate that the inhalation of aerosols from IQOS elicits a biological response similar to that of combustible cigarette smoke. In conclusion, our results provide evidence that the biological effects of HTPs, such as IQOS, cannot be ignored in the lungs. [ABSTRACT FROM AUTHOR]

The awareness of healthcare practitioners concerning heated tobacco product (HTP) use risks has been evaluated; however, few studies have investigated general dental practitioners' awareness regarding HTP-use risks. In this cross-sectional study, we investigated dentists' awareness of the risks of smoking, particularly HTP use. A self-administered questionnaire, including eight questions on conventional cigarette and HTP smoking/using status and both knowledge and awareness of HTP-use risks, was posted to 3883 dentists belonging to the Aichi Dental Association, Japan, in August 2019. Statistical analysis was performed using the Statistical Package for Social Sciences; statistical significance was set at p < 0.05. We analyzed the data of 1317 dentists (participation rate, 41.6%). The study group included cigarette smokers (11.5%) and HTP users (8.5%), among whom 41.1% were dual users. HTP users were more likely than never smokers/users to correctly perceive HTP-use risks (p < 0.05). This study indicates that in Japan, the proportion of HTP users is higher than that of the general population. It is important to educate not only smokers/users but also never smokers/users on the risks of smoking and using HTPs. Smoking cessation, including ceasing HTP use, and aiming to quit smoking and HTP use among dentists would contribute to appropriate smoking cessation among patients. [ABSTRACT FROM AUTHOR]

Tobacco and nicotine derivatives uses are multiple in nature. These include conventional cigarettes (CCs), heated tobacco products (HTPs), and electronic cigarettes (ECs). This study aims to determine the practices, nicotine dependency profile, association with exhaled carbon monoxide (eCO) level, and pulmonary function (PF) among adult product users and non-smokers. This cross-sectional study involved smokers, nicotine users, and non-smokers from two public health facilities in Kuala Lumpur from December 2021 to April 2022. Data on socio-demography, smoking profile, nicotine dependency level, anthropometry, eCO monitor, and spirometer measurements were recorded. Out of 657 respondents, 52.1% were non-smokers, 48.3% were CC only smokers, poly-users (PUs) (27.3%), EC-only users (20.9%), and HTP-only users (3.5%). EC use was prevalent among the younger aged, tertiary educated, and females; HTP use was prevalent among those of an older age and CC users was common among lower educated males. The highest median eCO (in ppm) seen were as follows: in CC users only (13.00), PUs (7.00), EC users (2.00), HTP users (2.00), and the least was observed among non-smokers (1.00), which is significantly different across the groups ( p <0.001). Comparison of practice between the different product users showed significant differences in age of product initiation ( p <0.001, youngest in CC users in PUs), duration of product use ( p <0.001, longest in exclusive CC users), cost per month ( p <0.001, highest in exclusive HTP users) and attempt to quit product ( p <0.001, CC use in PUs had the highest attempt to quit), while there is no significant difference in Fagerström score across the groups. Among EC users, 68.2% successfully switched from smoking CCs to ECs. The findings suggest that EC and HTP users are exhaling less CO. The use of these products in a targeted approach may manage nicotine addiction. Switching practice was higher among current EC users (from using CCs), hence emphasizing the need of switching encouragement and total nicotine abstinence later on. Lower eCO levels in the PU group, (as compared to CC-only users) and high quit attempt rate among in CC use in PUs may indicate attempt of PUs in reducing CC use through alternative modalities such as ECs and HTPs.

The actual use of heated tobacco products (HTPs) among smokers with rheumatoid arthritis (RA) is little known. The objective of this study was to clarify the prevalence and reasons for HTP use among smokers with RA. We administered a web survey to a research company panel in Japan between December 2020 and January 2021. After 170,000 panelists completed a primary questionnaire regarding smoking and disease status, 198 smokers with RA completed a secondary questionnaire regarding the reasons for HTP use and perceptions about the harmfulness of HTPs. The primary questionnaire revealed that smokers with RA were more likely to use HTPs than smokers without RA, and the adjusted odds ratio of RA for HTP use was one of the highest factors among other diseases (adjusted OR: 2.34, 95% CI: 1.92-2.85, p < 0.001). The secondary questionnaire revealed that 43.7% of HTP smokers with RA had considered using HTPs due to their RA, and 42.0% of them felt that starting HTPs relieved the symptoms of RA. These results indicated that smokers with RA tend to start using HTPs due to their RA, despite the lack of evidences that HTPs are safer alternatives.

This study explored subjective changes in tobacco product use during the COVID-19 pandemic. The online survey included 828 tobacco product users and was implemented from 20 August to 27 August 2021. Participants were classified based on currently used products (cigarettes, heated tobacco products (HTPs), and e-cigarettes) and categorized as single, dual, or triple users. Subjective changes in product use over the past year were designated as "no chang", "increase", or "decreased". Single use was most common, as reported by 447 participants (male 249, female 198), while 283 (male 164, female 119) and 98 (male 59, female 39) participants reported dual and triple use, respectively. Age, income, and triple use were associated with increased cigarette use, whereas living with family was associated with decreased use. Gender, age, income, and triple use were associated with the changed use of HTPs. No factors were significantly associated with an increase in e-cigarette use, whereas age and income were associated with decreased use. Similar to many COVID-19-related changes in cultural, social, and economic aspects of life, users' patterns of tobacco product use have also changed. Increasing tobacco product taxes, effective messaging, and customized cessation services might help prevent or limit tobacco product usage.

Although secondhand cigarette smoke is known to cause various health consequences, even the short-term effects of exposure to secondhand heated-tobacco-product (HTP) aerosol are unknown. The purpose of this study was to examine short-term symptoms related to secondhand HTP aerosol exposure. An internet-based self-reported questionnaire survey was conducted in 2019 as a part of the Japan Society and New Tobacco Internet Survey (JASTIS) study. In total, 8784 eligible respondents aged 15-73 years were analyzed. We examined the frequency (%) of secondhand combustible cigarette smoke and HTP aerosol exposure, and the exposure-related subjective symptoms (sore throat, cough, asthma attack, chest pain, eye pain, nausea, headache, and other symptoms). Overall, 56.8% of those exposed to secondhand cigarette smoke had any subjective symptoms, compared to 39.5% of those exposed to HTP aerosol. Asthma attack and chest pain were reported more frequently when associated with secondhand HTP exposure (10.9 and 11.8%, respectively) than with secondhand cigarette smoke exposure (8.4 and 9.9%, respectively). Sore throat, cough, eye pain, nausea, and headache were also more frequently reported when associated with secondhand cigarette smoke than with secondhand HTP exposure. This is the first study to examine severe subjective symptoms such as asthma attacks and chest pains, and to suggest that respiratory and cardiovascular abnormalities could be related to secondhand heated-tobacco-product aerosol exposure. Further careful investigations are necessary.

The heated tobacco product (HTP) IQOS was authorized for sale in the US in 2019. We investigated how young adults with experience using multiple tobacco products reacted to, perceived, and developed interest in IQOS, informing policies that might prevent HTPs from becoming ubiquitous. We used a novel qualitative method in which 33 young adult tobacco users in California (fall 2019) "unboxed" an IQOS device, tobacco sticks, and marketing materials and narrated their impressions and opinions. We conducted content and thematic analyses of participants' reactions, sensory experiences, and interest. Multiple attributes influenced appeal for participants, including sleek electronic design, novel technology, perceived harmfulness, complexity, and high cost. The "no smoke" claim and heating technology suggested that smoking IQOS was safer than smoking cigarettes. Public health programs should closely monitor HTP marketing and uptake, particularly as "reduced exposure" claims were authorized in July 2020. Evidence-based regulations (e.g., requiring plain packaging for tobacco sticks), actions addressing IQOS' unique attributes (e.g., regulating device packaging to reduce high-tech appeal), and public education might help to counter the appeal generated by potentially misleading IQOS marketing tactics.

The impact of heated-tobacco-products (HTPs) and electronic cigarettes (e-cigarettes) on youth is a controversial public health issue, as it is unknown whether alternative products result in more youth using such products or smoking. In Japan, e-cigarettes with nicotine are prohibited, but e-cigarettes without nicotine are available. HTPs are marketed as tobacco products. Within this unique context, we aimed to compare any conventional cigarette smokers (including those who also used alternative products) with exclusive users of alternative products and examine factors relating to their use in Japan. In 2017, 22,275 students in grades 7-9 (age 12-15) and 42,142 in grades 10-12 (age 15-18) nationwide were surveyed. Overall, 1.8% were current users of any of the three products over the last month. Multivariable analysis revealed that risk factors for alternative product use were the same as those for cigarette use. Among all users, exclusive new product users were more likely to participate in club activities and intend to continue to higher education; any conventional cigarette users (including those who also used alternative products) were more likely to be exposed to secondhand smoke at home and to drink alcohol. Reducing adult smoking and disseminating health education remain relevant as strategies for preventing adolescents' future tobacco use.

Background: We evaluated smokers' perceptions of heated tobacco products (HTPs) in Mexico, where industry publically lobbied to introduce HTPs into this country that banned both HTPs and e-cigarettes., Methods: Online surveys (November 2018 to July 2019) were analyzed from adults who only smoked cigarettes ( n = 2091) or who smoked and used e-cigarettes ("dual users" n = 1128). Logistic models regressed HTP awareness, interest to trying HTPs, and having seen HTPs for sale (only among aware participants) on sociodemographics and tobacco-related variables., Results: Of the 17.1% who were aware of HTPs, 52.7% reported having seen HTPs for sale. Of all respondents, 75% were somewhat or very interested in trying HTPs. Compared to their counterparts, more frequent smokers, dual users, those exposed to online e-cigarette ads, and those with friends who used e-cigarettes were both more aware of and interested in trying HTPs. Greater awareness was also associated with higher education, recent attempts to quit, receipt of email e-cigarette ads, and smoking among friends and family. Seeing HTPs for sale was higher for those who recently attempted to quit, were exposed to e-cigarette ads online or by email, or had friends who used e-cigarettes., Conclusion: Interest in HTPs is high among smokers in Mexico, which already has a large black market for illegal e-cigarettes. HTPs use should be monitored in this context, especially given the public health impacts of HTPs are unclear., Competing Interests: The authors declare no conflict of interest.

The awareness and use of the recently introduced heated product in the global tobacco market is rapidly increasing. Few studies have investigated the association of this product's use with health-related factors. To examine the association of the heated tobacco product (HTP)'s use with perceived stress, physical activity, and internet use, we analyzed data from the Korea Youth Risk Behavior Survey using multinomial logistic regression models. The participants included 60,040 students from middle school and high school. There were significant associations between high perceived stress and cigarette use only, dual use of cigarette and e-cigarette, triple use of cigarette, e-cigarette, and HTP; a negative association between HTP's use and perceived stress; positive association between physical activity and tobacco use; and not using the internet significantly increased the odds of use of all types of tobacco products. A smoking prevention program, tailored to meet the needs of different types of tobacco product users, is recommended. A program aimed at not only increasing awareness of perceived risk but also decreasing perceived benefits of risky behaviors, should also be considered. Further research using a longitudinal design to test the causal relationship of tobacco product use with perceived stress, physical activity, and internet use is warranted.