Gary Sweeney may be in a minority among people who quit smoking in his community in County Donegal, Ireland, but the method he used worked, so that doesn’t bother him one bit.
He started smoking at the age of 13—and continued for 30 years. During that time, he repeatedly tried to quit, using nicotine patches, gum and vapes.
“They didn’t really do anything for me,” he told Filter. “I didn’t care for vaping at all.”
Luckily, there was another option available. And this one helped him to stay off cigarettes long-term.
“As heated tobacco products can somewhat replicate the smoking experience, I found it much more suitable,” Sweeney said. “HTP is much closer to smoking, and I found it much more satisfying than the other products.”
Sweeney isn’t alone in that preference, or that experience. Although only 1.2 percent of Ireland’s adult population currently use HTP (compared to 11.2 percent using vapes), that still equates to almost 50,000 people who could otherwise be smoking.
“They felt closer to my usual habits, so for me, the switch was easier and more natural.”
Felisia Porcaro, who lives in Italy, quit smoking the same way. “I had looked at other alternatives, but HTPs worked best for me,” she told Filter. Just like Sweeney, she cited the products’ ability to mimic smoking as the key factor.
“They felt closer to my usual habits, so for me, the switch was easier and more natural,” she said.
Unlike vapes or nicotine pouches, heated tobacco products actually involve tobacco. You insert a stick of tobacco into an electronic device, which heats it up. Critically, the tobacco is not burned—the devices have also been known as “heat not burn” products—just heated enough to emit an aerosol containing nicotine, which is then inhaled. The absence of combustion is why HTP use is harm reduction.
Other consumers find further advantages. “For me, it wasn’t so much the familiarity of a tobacco stick,” Lindsay Reese, who lives in Switzerland and quit cigarettes with HTP, told Filter. “It was the finite experience.”
“Vapes keep going and going,” she explained, “but when the consumable is a stick it is more like… Ok, I’m going to take these five minutes to relax, as opposed to hitting a vape every 10 minutes.”
Despite their obvious appeal to some and their availability in an estimated 69 countries, it can feel to people in the Western world that HTP have not matched the popularity of vapes and pouches. In truth, there is a clear global divide: HTP have taken off in parts of East Asia, but much less so in Europe and North America.
“This creates an information gap. Adults should have access to clear, balanced and evidence-based information on all alternatives to combustible cigarettes.”
Francesco Luongo is the president of Heated Community Hub, a consumer advocacy group. He thinks one big reason for the global mismatch is a question of public consciousness in the West.
Vapes “have been more visible in the media, in public policy debates and in broader consumer awareness,” he told Filter. “Heated tobacco products, by contrast, have often remained in the background, even though they are part of the wider tobacco harm reduction discussion.”
Another factor, Luongo continued, is that the products tend to be viewed through an industry lens. The high costs and logistics of production, including the required research, mean that the HTP market is completely dominated by tobacco companies with deep enough pockets. While that doesn’t reduce the inherent validity of HTP as a harm reduction option, it does mean bad PR.
“From our perspective, this creates an information gap,” Luongo explained. “Adults should have access to clear, balanced and evidence-based information on all alternatives to combustible cigarettes, including HTPs.”
Another drawback of the current HTP landscape is that each brand has its own tobacco sticks, which aren’t compatible with other brands’ devices. This helps keep costs for consumers higher.
Though Sweeney is continuing to use the product that enabled him to quit cigarettes, he does consider this a major negative. “The main problem I have with them is the cost of replacement sticks,” he said. “More people would probably use them as a replacement for smoking if the cost was lower.”
“Many people still do not know the difference between cigarettes and heated tobacco products, and this creates confusion and prejudice.”
In Italy, 4.5 percent of the adult population use HTP—making it a rare European country where they’ve achieved that kind of popularity. But even there, Porcaro said, public information about the products “is still quite limited.”
She credited the internet, retailers and the tobacco harm reduction community for giving her the knowledge to try replacing cigarettes with HTP. But too many remain unaware of this method of reducing their exposure to health risks.
“I think many people still do not know the difference between cigarettes and heated tobacco products, and this creates confusion and prejudice,” Porcaro said.
On top of the general climate of misinformation around tobacco harm reduction, the fact that many studies on the efficacy of HTP are industry-led may add to public skepticism. However, since 2024, over 400 independent studies that “support their use as a safer alternative to smoking” have been published, according to a briefing paper by the Global State of Tobacco Harm Reduction.
Such assessments are complex, and experts are often reluctant to put a simple figure on relative risk, given toxic politics and many unknowns. But there is a consensus that HTP use is substantially safer than smoking. One widely cited 2022 study indicates that it’s about 20 times less risky.
Among those calling for more independent research is Dr. Harry Tattan-Birch, a researcher at University College London’s Department of Behavioural Science and Health. He has been involved in studies looking at the effects of HTP use.
“Heated tobacco products are likely to be a lot less harmful than cigarettes, but probably more harmful than vaping.”
“Based on a selection of randomized controlled trials, we found moderate-certainty evidence that people using heated tobacco products had lower exposure to many toxicants and carcinogens than cigarette smokers,” he told Filter.
Tattan-Birch added that this was “unsurprising,” since the products don’t burn tobacco. “Combustion is the main source of many harmful chemicals in cigarette smoke.”
Burning at 800 degrees Celsius, cigarettes produce over 4,000 chemicals in the smoke, including at least 70 known carcinogens. HTP devices heat tobacco to around 350 °C, producing fewer harmful chemicals—though not none.
Tattan-Birch said exposure from HTP use was higher than when people stop using tobacco altogether, and generally higher than levels seen with vaping.
“Taken together,” he said, the evidence “suggests heated tobacco products are likely to be a lot less harmful than cigarettes, but probably more harmful than vaping, and of course more harmful than not using nicotine or tobacco at all.”
People deserve to know all that as they weigh their choices. But as well as the relative risks of use, another factor is how effectively a tobacco harm reduction product can shift people away from the most dangerous option—cigarettes—at a population level.
Researchers found that from 2016-2019, immediately after HTP were first marketed in Japan, the decline in cigarette sales was five times faster.
One country above all is the leading example to show that HTP can be very effective indeed.
Japan, where the smoking rate among men aged 20-29 once stood at 79 percent in groups of men aged between 20-29, has halved its smoking rate in just a decade—a globally unprecedented achievement.
This has largely been attributed to the soaring popularity of HTP. While Japan’s smoking rate was already falling, researchers found that from 2016-2019, immediately after HTP were first marketed in the country, the decline in cigarette sales was five times faster than in the previous few years.
Other countries have also recognized the potential. Even the United States Food and Drug Administration, not known as a tobacco harm reduction champion, first authorized some HTP to be marketed as “modified risk” back in 2020. In 2023, the FDA authorized three new HTP, reasoning that, “the net population-level benefits to adult smokers outweigh the risks to youth.”
In 2024, New Zealand decided to halve its tax on HTP in a bid to encourage more people to quit smoking. The country had already accelerated smoking cessation by embracing vaping as harm reduction, and now has one of the world’s lowest smoking rates. But as a health minister said at the time, “Vaping does not work for everyone,” so they also wanted to make alternatives more accessible.
“If they help some smokers move away from combustible cigarettes, they deserve to be part of the conversation.”
There’s always a backlash somewhere, and the United Kingdom is currently looking to limit HTP use by banning it from various public spaces. Outside hospitals, vaping will be permitted but HTP use will not—indicating a dismissal of the latter’s harm reduction role.
Dr. Riccardo Polosa, a professor of internal medicine at the University of Catania, Italy, said the proposed ban “muddled the message” that HTP are smoking cessation tools, not cigarettes.
“Quite frankly, I don’t see the urgency here as heated tobacco use in the UK is well under 1 percent of adults,” he told Filter. “Use is largely concentrated among people who already smoke or smoked in the recent past, so the ban looks like a solution in search of a problem.”
“It is also worth mentioning that, although not risk-free, HTPs expose users and bystanders to much lower levels of harmful compounds than cigarette smoke,” Polosa continued. “So banning them in open-air spaces around hospitals is unlikely to deliver any meaningful health gain.”
Helping people quit smoking, however, is about the most meaningful health gain imaginable. And when HTP work for many and are much safer than cigarettes, they fully merit being on a menu varied enough to save as many lives as possible.
“The key point is adult smokers should have access to different alternatives and to correct information, so they can find the option that works best for them,” Luongo said. “If HTPs help some smokers move away from combustible cigarettes, they deserve to be part of the conversation.”
Correction, March 25: The original version of this article misspelled Felisia Porcaro’s name.
Photograph by the Global State of Tobacco Harm Reduction, via Flickr/Creative Commons 2.0
The Influence Foundation, which operates Filter, has received grants and donations from Knowledge-Action-Change, which publishes the Global State of Tobacco Harm Reduction. Both The Influence Foundation and the Center of Excellence for the Acceleration of Harm Reduction at the University of Catania, founded by Dr. Polosa, received grants from Global Action to End Smoking. Filter’s Editorial Independence Policy applies.