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Heat-not-burn tobacco products: concerns from the Italian experience
  1. Xiaoqiu Liu1,
  2. Alessandra Lugo1,
  3. Lorenzo Spizzichino2,
  4. Takahiro Tabuchi3,
  5. Roberta Pacifici4,
  6. Silvano Gallus1
  1. 1 Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
  2. 2 Prevention Department, Ministry of Health, Rome, Italy
  3. 3 Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  4. 4 National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
  1. Correspondence to Dr Silvano Gallus, Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”, Milan 20156, Italy; silvano.gallus{at}

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Heat-not-burn (HNB) tobacco products are disposable tobacco sticks heated, rather than combusted, by an electronic device to generate an aerosol containing nicotine.1 IQOS is the brand name of such a product by Philip Morris International, launched in 2014 in Italy as a pilot country for the European market. IQOS is now in commerce in 30 countries, including 19 European ones, and applications have been submitted to market it as a modified risk tobacco product in the USA.

Most safety data on this new tobacco product come from research conducted by the tobacco industry.2 The few independent toxicological studies confirm that HNBs release harmful and potentially harmful substances, although at reduced levels as compared with conventional cigarettes.1 3 4 To our knowledge, the only available studies on the use of HNBs are two repeated online surveys on Japanese adult population, showing a prevalence of IQOS users of 0.3% in …

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  • Contributors SG and RP had the original idea for the study; XL and SG drafted the research letter; AL and XL conducted the data analysis; XL, AL, TT and SG gave substantial contribution to conception, design and interpretation of data; RP and LS gave contributions to conception and design of the study and provided data from the survey; all authors critically revised the manuscript and approved its final version.

  • Funding The surveys were conducted with the contribution of the Italian Ministry of Health. The work of RP was partially funded by the Italian Ministry of Health (MADES project, chapter 4100/22). The work of AL was supported by a fellowship from the Italian Association for Cancer Research (AIRC). The work of SG and XL was partially supported by the Italian League Against Cancer (Milan).

  • Competing interests None declared.

  • Ethics approval The ethics committee of Istituto Neurologico Carlo Besta–Milano acknowledged the collection of anonymous data in face-to-face population-based, observational, cross-sectional studies (File number 37, 2017).

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

  • Data sharing statement No additional unpublished data are available.