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Heated tobacco products likely appeal to adolescents and young adults
  1. Karma McKelvey1,
  2. Lucy Popova2,
  3. Minji Kim3,
  4. Benjamin W Chaffee4,
  5. Maya Vijayaraghavan5,
  6. Pamela Ling3,
  7. Bonnie Halpern-Felsher1
  1. 1 Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
  2. 2 School of Public Health, Georgia State University, Atlanta, Georgia, USA
  3. 3 Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
  4. 4 Division of Oral Epidemiology and Dental Public Health, University of California, San Francisco, California, USA
  5. 5 General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
  1. Correspondence to Dr Bonnie Halpern-Felsher, Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Palo Alto CA 94402, USA; bonnieh{at}


Background Beginning in the 1960s in the USA and globally since 1998, tobacco companies have beenaggressively promoting heated tobacco products (HTP). In 2016, Philip Morris International (PMI) applied to the US Food and Drug Administration (FDA) seeking authorisation to market their IQOS HTP system and flavoured ‘HeatSticks’ in the USA as a modified-risk tobacco product (MRTP).

Methods We systematically evaluated the publicly available data PMI submitted to FDA in its MRTP application to determine whether PMI’s IQOS product meets the US Tobacco Control Act’s standard for MRTP claims. We examined whether PMI provided sufficient data showing tobacco users will not initiate with IQOS, that youth will not misperceive the MRTP-related claims being made concerning IQOS, and how youth perceive health risks associated with IQOS.

Results PMI’s own studies failed to provide evidence that youth, including non-users and former users, will not find IQOS appealing, will not initiate use of IQOS and will not perceive these products as risk-free. Further, PMI did not refer to independent studies conducted among adolescents which could influence their conclusions. Finally, their studies suffered from design and implementation flaws and cannot be relied on to support the proffered claims.

Conclusion PMI’s own data and available evidence from scientific studies conducted independent of the tobacco industry regarding how novel tobacco products are currently being marketed suggest that introduction of IQOS will result in adolescent and young adult non-users initiating tobacco use with IQOS and could also increase poly-use of IQOS along with other tobacco products.

  • electronic nicotine delivery devices
  • non-cigarette tobacco products
  • packaging and labelling
  • public policy
  • tobacco industry

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors All authors contributed to the literature review, analyses and writing of the paper.

  • Funding This work was supported by the US National Cancer Institute and Food and Drug Administration Center for Tobacco Products (P50 CA180890, R00 CA187460) and the National Institute of Drug Abuse and Food and Drug Administration Center for Tobacco Products (P50 DA036128).

  • Disclaimer The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health or the FDA. The funding agencies played no role in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.