But there is concern among public health experts that if young people who have never smoked cigarettes really are drawn to heated tobacco products, it could introduce new groups of people to potentially harmful habits.
In 2024, Gallus and a group of fellow tobacco control researchers in Italy published a study based on data from more than 3,000 Italians aged between 18 and 74, who they tracked for six months during 2020. They found that non-smokers who began using heated tobacco products were 5.8 times as likely to subsequently transition to smoking within the six month study period as people who had never used heated tobacco products.
“We know that this product is a gateway to conventional cigarettes,” says Gallus. It is a concern shared by other researchers.
But PMI describes Gallus’ study as unreliable and says that heated tobacco can provide a route out of smoking. Gallus and his colleagues acknowledge themselves that their study had a limited sample size and needs to be verified with larger studies. The results may also have been impacted by the pandemic and widespread lockdowns which were taking place at the time.
Researchers like Gallus, however, view heated tobacco products as a setback in the battle to drive down tobacco use and have accused the industry of cynically targeting young people. They point to the fact that, to date, marketing for IQOS has appeared at music festivals and film festivals in Europe, Asia and South America, alongside high profile partnerships with streetwear brands and fashion designers.
It is a concern echoed by the World Health Organization (WHO). In a 2023 summary of evidence, experts at the WHO warned that the lower cost of heated tobacco sticks compared to a pack of cigarettes “undermines the progress made in reducing use that was accomplished by making products more expensive”. The report, which was funded by Bloomberg Philanthropies, an organisation that invests heavily in reducing tobacco use, added that the marketing of heated tobacco products often combined claims of reduced harm relative to cigarettes with “the passion for technology of primarily young people”.
According to a report produced by the non-profit organisation Campaign for Tobacco-Free Kids – which also receives funding from Bloomberg Philanthropies – influencer-driven campaigns on social media platforms such as Instagram, Facebook, TikTok, X (formerly Twitter) and YouTube have also played a key role in raising the visibility of IQOS and other heated tobacco brands. A study by researchers at the University of Rochester in the US also found that Instagram posts featuring heated tobacco products often position the devices as lifestyle products by showing them alongside models, swimming pools or a luxury car. Posts with models or lifestyle elements received higher engagement.
PMI categorically denies marketing its heated tobacco products to young people and says it does not have an official account on TikTok, while its account on X is used for customer care only. The company also says at least 75% of the audience must be over the legal age for purchasing tobacco products at any third-party events it sponsors. PMI claims 82% of IQOS users are over the age of 29, according to its own estimates.
Getty ImagesBut the debate over the marketing of heated tobacco also obscures another issue – these products are so new that there is still little research to assess their long-term health effects.
Most research on the vapour emissions from heated tobacco products have been funded by tobacco companies or carried out by scientists directly employed by them. They show that heated tobacco aerosols contain significantly fewer harmful compounds than cigarette smoke.
Some studies have also found that switching from cigarettes to heated tobacco can be beneficial in some people – such as patients with chronic lung disease. But other scientific research also suggests that heated tobacco products are unlikely to be benign for our health.