Correspondence to Yoo Jin Cho, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; [email protected]
Heated tobacco products (HTPs), or ‘heat-not-burn tobacco products’, are battery-powered devices that deliver nicotine to the user by heating a tobacco stick, instead of combusting tobacco like conventional cigarettes or heating liquids like electronic cigarettes.1 2 Philip Morris International (PMI) launched its HTP, I Quit Ordinary Smoking (IQOS), in Japan in November 2014. Since then, PMI has rapidly expanded the IQOS market. PMI’s CEO has publicly expressed a belief in HTPs’ commercial success in upcoming years.3 As of July 2018, IQOS is sold in 37 countries,4 with evidence of rapidly increasing sales.5–9 To help ensure that potentially reduced harm products like HTPs benefit public health, the tobacco control community must monitor industry behaviour around HTPs.
In November 2017, KT&G, the largest Korean tobacco company, introduced the product innovation of tobacco sticks with flavour capsules for HTPs (hereafter capsule heat-sticks) into the Korean market. The filters for capsule heat-sticks include a small case that contains flavouring agents, and consumers are to crush the capsule at any time during a smoking session to flavour the aerosol. Flavour capsules for conventional cigarettes work the same way and were first introduced in Japan in 2007, followed by their rapid introduction and growth in cigarette market share around the world.10 11 Capsule cigarette flavours originally included only menthol, but flavours have expanded to include fruits (eg, mango, cherry, grape, lemon, strawberry and orange) and drinks (mojito).12 13 Some capsule cigarettes even include two capsules with different flavours in the filter, and some brand varieties include multiple capsule flavours for different cigarette sticks inside a single pack.14 In Korea, there are at least 35 flavour capsule cigarette brand varieties available.13
Capsule heat-sticks are a key innovation for KT&G’s attempt to attain market share for its HTPs in Korea, where PMI successfully launched IQOS in June 2017.15 Indeed, while IQOS heat-sticks (HEETS) include a variety of flavours (tobacco, menthol, bubble gum and lime), no IQOS heat-sticks include capsules. Furthermore, when British American Tobacco (BAT) introduced its ‘glo’ HTP into the Korean market in August 2017, their heat-sticks (Dunhill Neosticks) did not include capsules. Like IQOS, the heat-sticks included flavour options (tobacco, menthol and lemon ginger), with three additional flavours introduced in December 2017 (‘Ruby fresh (cherry)’, ‘purple fresh (grape)’ and ‘smooth fresh (light menthol)’). By contrast, when KT&G introduced its HTPs under the ‘lil’ (a Little Is a Lot) brand name in November 2017, all the lil heat-sticks (Fiit) included capsules (menthol and bubble gum flavours; see figure 1). In April 2018, KT&G further extended its offerings by introducing a capsule heat-stick named ‘Fiit SPARKY (menthol and apricot flavour)’. In the same month, BAT introduced Dunhill Neostiks with capsules for glo ‘Boost (strong menthol)’ and ‘Switch (tobacco and light menthol)’.
Figure 1. Flavor capsule cigarettes ‘Fiit’ for heat-not-burn tobacco product ‘lil’. The warning label covers 50% of the front of the pack and writes ‘Caution for addiction. Sales are prohibited for adolescents aged less than 19 years! Electronic tobacco causes nicotine addiction. Quitline 1544-9030’.
HTP product innovations appear to be gaining in popularity in Korea. Sales of HTPs increased in terms of both the volume and market share between May 2017 to March 2018, with approximately 163 million packs of heat-sticks sold, with each pack containing 20 heat-sticks.16 Government data suggest that heat-sticks accounted for an estimated 8.6% of the market share for all tobacco products in February 2018, which was almost triple their market share (3%) in July 2017.17
The market share for capsule heat-sticks is currently unknown, but the rapid introduction of the HTP innovation into the Korean market along with the high market share for capsule cigarettes suggests that they are likely to be successful. Capsule cigarettes were first introduced in Korea by BAT in 2010 (KENT Convertibles), and KT&G introduced the world’s first ultraslim capsule cigarette brand, Esse Change, in Korea in 2013.18 The market share of flavour capsule cigarette increased from 2.3% in 2012 to 15.0% in 2015 in Korea.19 Given that capsule cigarettes appeal to youth20 21 and are perceived as more stylish and less harmful than regular cigarettes,22 capsule heat-sticks may also appeal to youth. Like capsule cigarettes, capsule heat-sticks contain menthol23 and other flavours that can mask the harshness of tobacco24 and may appeal to female and young non-smokers.21 25–28 Therefore, it is critical to monitor the growth, toxicity and potential public health impact of heat-sticks with and without flavour capsules, as well as the continuing growth of capsule cigarettes.
Contributors Both authors designed, drafted and revised the paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
1 Farsalinos KE, Yannovits N, Sarri T, et al. Nicotine delivery to the aerosol of a heat-not-burn tobacco product: comparison with a tobacco cigarette and E-Cigarettes. Nicotine Tob Res 2018; 20: ntx138. doi:10.1093/ntr/ntx138
2 McNeill A, Brose LS, Calder R, et al. Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England, 2018. (accessed 17 Apr 2018).
3 Caputi TL. Industry watch: heat-not-burn tobacco products are about to reach their boiling point. Tob Control 2016; 26: 609–10. doi:10.1136/tobaccocontrol-2016-053264
4 IQOS. Phillip Morris: smoke-free products. https://www.pmi.com/smoke-free-products/iqos-our-tobacco-heating-system (accessed 17 Jul 2018).
5 Caputi TL, Leas E, Dredze M, et al. They’re heating up: Internet search query trends reveal significant public interest in heat-not-burn tobacco products. PLoS One 2017; 12: e0185735. doi:10.1371/journal.pone.0185735
6 Tabuchi T, Gallus S, Shinozaki T, et al. Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol. Tob Control 2018; 27: e25–33. doi:10.1136/tobaccocontrol-2017-053947
7 Tabuchi T, Kiyohara K, Hoshino T, et al. Awareness and use of electronic cigarettes and heat-not-burn tobacco products in Japan. Addiction 2016; 111: 706–13. doi:10.1111/add.13231
8 Liu X, Lugo A, Spizzichino L, et al. Heat-not-burn tobacco products: concerns from the Italian experience. Tob Control 2019; 28: 113–4. doi:10.1136/tobaccocontrol-2017-054054
9 Brose LS, Simonavicius E, Cheeseman H. Awareness and Use of’Heat-not-burn' tobacco products in Great Britain. Tob Regulat Sci 2018; 4: 44–50. doi:10.18001/TRS.4.2.4
10 Euromonitor International. Tobacco: euromonitor passport database. London: Euromonitor International, 2014.
11 Thrasher JF, Islam F, Barnoya J, et al. Market share for flavour capsule cigarettes is quickly growing, especially in Latin America. Tob Control 2017; 26: 468–70. doi:10.1136/tobaccocontrol-2016-053030
12 Institute for Global Tobacco Control. Tobacco pack surveillance system:TPackSS. https://www.globaltobaccocontrol.org/tpackss/pack-search/ (accessed 26 Apr 2018).
13 Kim H. 2017. Research on the impact of flavored tobacco products on smoking initiation. https://goo.gl/hGFdSe (accessed 26 Apr 2017).
14 Euromonitor International. Global Tobacco: key findings part I - cigarettes. 2017.
15 Kim M. Philip Morris International introduces new heat-not-burn product, IQOS, in South Korea. Tob Control 2018; 27: e76–8. doi:10.1136/tobaccocontrol-2017-053965
16 Yonhap News Agency. 2018. Sales of HNB e-cigarettes grow fast since debut last year: Yonhap News. http://english.yonhapnews.co.kr/search1/2603000000.html?cid=AEN20180516002600320
17 Yonhap News Agency. 2018. Cigarette-caused fires dip amid popularity of HNB tobacco products: Yonhap News. http://english.yonhapnews.co.kr/search1/2603000000.html?cid=AEN20180629003700315
18 KT&G. The history of KT&G. http://en.ktng.com/history?mode=GLOBAL (accessed 17 Apr 2018).
19 Kim J. 2017. Measures to control the risks of flavored tobacco products: weekly issue. https://www.khealth.or.kr:8443/b/16/9561 (accessed 17 Apr 2018).
20 Emond JA, Soneji S, Brunette MF, et al. Flavour capsule cigarette use among US adult cigarette smokers. Tob Control 2018; 27: 650–5. doi:10.1136/tobaccocontrol-2017-054198
21 Abad-Vivero EN, Thrasher JF, Arillo-Santillán E, et al. Recall, appeal and willingness to try cigarettes with flavour capsules: assessing the impact of a tobacco product innovation among early adolescents. Tob Control 2016; 25: e113–9. doi:10.1136/tobaccocontrol-2015-052805
22 Thrasher JF, Abad-Vivero EN, Moodie C, et al. Cigarette brands with flavour capsules in the filter: trends in use and brand perceptions among smokers in the USA, Mexico and Australia, 2012-2014. Tob Control 2016; 25: 275–83. doi:10.1136/tobaccocontrol-2014-052064
23 Kim HS, Pack EC, Koo YJ, et al. Quantitative analysis of menthol and identification of other flavoring ingredients in capsule cigarettes marketed in Korea. Regul Toxicol Pharmacol 2018; 92: 420–8. doi:10.1016/j.yrtph.2018.01.002
24 Yerger VB, McCandless PM. Menthol sensory qualities and smoking topography: a review of tobacco industry documents. Tob Control 2011; 20: ii37–43. doi:10.1136/tc.2010.041988
25 Moodie C, Ford A, Dobbie F, et al. The power of product innovation: smokers' perceptions of capsule cigarettes. Nicotine Tob Res 2018; 20: ntx195. doi:10.1093/ntr/ntx195
26 Moodie C, Ford A, Mackintosh A, et al. Are all cigarettes just the same? Female’s perceptions of slim, coloured, aromatized and capsule cigarettes. Health Educ Res 2015; 30: 1–12. doi:10.1093/her/cyu063
27 German Cancer Research Center. Menthol capsules in cigarette filters–increasing the attractiveness of a harmful product Heidelberg, Germany. 2012.
28 Huang LL, Baker HM, Meernik C, et al. Impact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review. Tob Control 2017; 26: 709–19. doi:10.1136/tobaccocontrol-2016-053196
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Abstract
Correspondence to Yoo Jin Cho, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; [email protected] Heated tobacco products (HTPs), or ‘heat-not-burn tobacco products’, are battery-powered devices that deliver nicotine to the user by heating a tobacco stick, instead of combusting tobacco like conventional cigarettes or heating liquids like electronic cigarettes.1 2 Philip Morris International (PMI) launched its HTP, I Quit Ordinary Smoking (IQOS), in Japan in November 2014. Flavour capsules for conventional cigarettes work the same way and were first introduced in Japan in 2007, followed by their rapid introduction and growth in cigarette market share around the world.10 11 Capsule cigarette flavours originally included only menthol, but flavours have expanded to include fruits (eg, mango, cherry, grape, lemon, strawberry and orange) and drinks (mojito).12 13 Some capsule cigarettes even include two capsules with different flavours in the filter, and some brand varieties include multiple capsule flavours for different cigarette sticks inside a single pack.14 In Korea, there are at least 35 flavour capsule cigarette brand varieties available.13 Capsule heat-sticks are a key innovation for KT&G’s attempt to attain market share for its HTPs in Korea, where PMI successfully launched IQOS in June 2017.15 Indeed, while IQOS heat-sticks (HEETS) include a variety of flavours (tobacco, menthol, bubble gum and lime), no IQOS heat-sticks include capsules. Sales of HTPs increased in terms of both the volume and market share between May 2017 to March 2018, with approximately 163 million packs of heat-sticks sold, with each pack containing 20 heat-sticks.16 Government data suggest that heat-sticks accounted for an estimated 8.6% of the market share for all tobacco products in February 2018, which was almost triple their market share (3%) in July 2017.17 The market share for capsule heat-sticks is currently unknown, but the rapid introduction of the HTP innovation into the Korean market along with the high market share for capsule cigarettes suggests that they are likely to be successful. Capsule cigarettes were first introduced in Korea by BAT in 2010 (KENT Convertibles), and KT&G introduced the world’s first ultraslim capsule cigarette brand, Esse Change, in Korea in 2013.18 The market share of flavour capsule cigarette increased from 2.3% in 2012 to 15.0% in 2015 in Korea.19 Given that capsule cigarettes appeal to youth20 21 and are perceived as more stylish and less harmful than regular cigarettes,22 capsule heat-sticks may also appeal to youth.
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