2020 National Youth Tobacco Survey Introduced U.S. Youth to Heat-Not-Burn Tobacco Brands

 

Anti-tobacco crusaders continue to promote e-cigarettes and vape products to the nation’s youth.

ABC News has published a screed by University of Chicago pediatric resident physician Chidimma Acholonu in which she claims that “now a new smoke-free alternative called heated tobacco  is slowly gaining a foothold in the U.S. market…While heated tobacco products [known as heat-not-burn, HNB] only became legal in the United States in 2019, the device have [sic] already started to catch the attention of high school students.”

Dr. Acholonu credits unnamed “experts” for news that “Tobacco companies are attempting to glamorize these products.” How? Erika Sward, assistant vice president for advocacy at the American Lung Association, says, “[Tobacco companies are] attempting to make the packaging and the marketing look white and clear and clean and very modern.”

Huh? A teen HNB epidemic is going to be driven by white, clear, clean and modern packaging?

Dr. Acholonu is wrong when she says that HNBs “only became legal in the United States in 2019.” Reynolds’ Eclipse has been on and off the U.S. market for about 20 years, although it has never proven to be a viable substitute for combusted cigarettes.

Dr. Acholonu was probably referring to IQOS. The FDA authorized IQOS sales in 2019, and the agency approved a reduced exposure claim in 2020, saying its decision “is expected to benefit the health of the population as a whole.” IQOS has driven an unprecedented decline in cigarette consumption in Japan, and it is now available in more than 60 countries.

To analyze Dr. Acholonu’s claim that HNBs are catching the attention of high schoolers, let’s take a close look at the 2020 National Youth Tobacco Survey, which described HNB products this way:

“Some people refer to these products as ‘heat-not-burn’ tobacco products. Heated tobacco products heat tobacco sticks or capsules to produce a vapor. They are different from e-cigarettes, which heat a liquid to produce a vapor. Some brands of heated tobacco products include iQOS, glo, and Eclipse.”

Only 202 of the 14,531 students surveyed had used HNBs during the past 30 days, which represents about 1.4% of all U.S. middle and high school students. But there’s more.

The NYTS survey asked participants “Before today, have you heard of heated tobacco products?”  The survey provided a handy description, saying that HNBs “are different from e-cigarettes, which heat a liquid to produce a vapor.”  Just in case the kids were still unsure, the survey taught them some brands to look for: “Some brands of heated tobacco products include iQOS, glo, and Eclipse.” 

Over 11,600 (80%) of middle and high school students had not heard of HNBs. For these youths, the NYTS was their first introduction to iQOS, glo and Eclipse.

Let’s get back to the 202 HNB current users: 61 of them had never heard of HNBs “before today.” If they never heard of them, they didn’t use them, so they shouldn’t be counted. 

Now we have 141 HNB users, 67 of whom said they had used one or more of the following HNB flavors: clove, spice, chocolate, wine, cognac, cocktail flavors, candy, dessert, or sweets.  This is impossible, as IQOS and Eclipse are not sold in any of these flavors. Those 67 should not be counted.

Now we have 74 kids who said they are HNB users, which works out to be 0.4% of middle school students and 0.7% of high schoolers. With only limited availability of HNB products, it is likely that many of those respondents were mistaken, answering “yes” to the HNB question when they meant e-cigarettes or vapor products. In fact, among current HNB users, 60% were current e-cigarette users; only 14% were not using any other tobacco product.

In summary, the 2020 NYTS introduced large numbers of middle and high school students to HNB products for the first time. No amount of misinformation, like the ABC News story, can alter the facts about the phony “next teen tobacco epidemic.”

 

Instead of Greenlighting IQOS Sales, FDA Continues to Slow-Walk Safer Cigarette Substitutes

The introduction of heat-not-burn cigarette substitutes in Japan has led to a precipitous reduction in cigarette consumption.  

Tobacco industry analyst Michael Livery of Piper Jaffray recently issued a report on the Japanese market, citing 2017 sales data. The chart at left suggests that Philip Morris International’s IQOS heat sticks (green) and BAT’s Glo products (blue) caused a 13% decline in cigarette consumption for the year.  Livery deliberately underestimated the number of heat sticks sold because of evidence that up “to 20% (4^th Quarter 2017) of iQOS HeatStick volumes…is getting re-sold in China, Thailand, and Hong Kong, and likely other parts of Asia.”

I suggested (here) that a similar result could be possible in the U.S., if the FDA grants marketing approval for such products. The agency, however, appears to be in no rush to make a decision.

Philip Morris submitted a premarket tobacco application (PMTA) to the FDA on March 31, 2017; it has been pending ever since.

According to the FDA (here), if a PMTA is accepted and found to be complete, the agency will file it and begin substantive review.  “After completing its review, FDA intends to issue an order within 180 days after receipt of the Premarket Tobacco Application that the new product may or may not be introduced or delivered for introduction to consumers.” (emphasis added)

The FDA took eight months to grant Swedish Match a PMTA for eight snus products in 2015 (here).  This week marks the twelfth month of FDA consideration of the IQOS PMTA submitted March 31, 2017.

It is often said that regulation is a slow, deliberate process.  But in this instance the FDA is in apparent violation of its own procedural guidelines.  The FDA simply slow walks any decision on safer options for smokers: it took 2.5 years (here) and 4 years (here) to reject requests to correct inaccurate smokeless tobacco warnings.  All of these are examples of regulatory purgatory that I warned about six years ago (here). 

Our country’s smokers and their loved ones deserve better.