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Analysis of mainstream emissions, secondhand emissions and the environmental impact of IQOS waste: a systematic review on IQOS that accounts for data source
  1. Malak El-Kaassamani1,
  2. Miaoshan Yen2,3,
  3. Soha Talih3,4,
  4. Ahmad El-Hellani3,5,6
  1. 1Department of Chemistry, American University of Beirut Faculty of Arts and Sciences, Beirut, Lebanon
  2. 2Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
  3. 3Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
  4. 4Department of Mechanical Engineering, American University of Beirut Faculty of Engineering and Architecture, Beirut, Lebanon
  5. 5Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, Ohio, USA
  6. 6Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
  1. Correspondence to Dr Ahmad El-Hellani, Division of Environmental Health Sciences, The Ohio State University College of Public Health, Columbus, OH 43210, USA; elhellani.1{at}


Objective To highlight the general features of IQOS literature focusing on the chemical analysis of IQOS emissions.

Data sources PubMed, Web of Science and Scopus databases were searched on 8 November 2021 using the terms ‘heated tobacco product’, ‘heat-not-burn’, ‘IQOS’ and ‘tobacco heating system’ with time restriction (2010–2021). The search yielded 5480 records.

Study selection Relevant publications on topics related to IQOS assessment were retrieved (n=341). Two reviewers worked separately and reached agreement by consensus.

Data extraction Data on author affiliation and funding, article type and date of publication were extracted. Publications were categorised depending on their focus and outcomes. Data on IQOS emissions from the chemical analysis category were extracted.

Data synthesis Of the included publications, 25% were published by Philip Morris International (PMI) affiliates or PMI-funded studies. PMI-sponsored publications on emissions, toxicology assessments and health effects were comparable in number to those reported by independent research, in contrast to publications on IQOS use, market trends and regulation. Data on nicotine yield, carbonyl emissions, other mainstream emissions, secondhand emissions and IQOS waste were compared between data sources to highlight agreement or disagreement between PMI-sponsored and independent research.

Conclusions Our analysis showed agreement between the data sources on nicotine yield from IQOS under the same puffing conditions. Also, both sources agreed that IQOS emits significantly reduced levels of some emissions compared with combustible cigarettes. However, independent studies and examination of PMI’s data showed significant increases in other emissions from and beyond the Food and Drug Administration’s harmful and potentially harmful constituents list.

  • harm reduction
  • non-cigarette tobacco products
  • public policy
  • tobacco industry
  • toxicology

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  • Contributors AE-H conceived the study idea. AE-H and ME-K designed and conducted the literature search. ME-K and AE-H extracted and synthesised the data. AE-H wrote the first and final version of the manuscript. ST and MY performed the statistical analysis. All authors revised the manuscript and have approved its final version.

  • Funding This study was supported by a Rapid Response Project subaward under grant number U54DA036105 from the National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the US Food and Drug Administration.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.