Health experts worried about rise of cigarette substitutes

‘In the past two years, I have sold more tobacco sticks than I could ever have imagined’

They have long been promoted as a way to help smokers stop, but it is increasingly clear that vapes and heated tobacco devices are more often than not a long-term substitute to real cigarettes.

And while these electronic or disposable devices may not contain the tar of cigarettes, health authorities are concerned that there are still health risks, that much of the market – especially with vapes – remains unregulated and their appeal to the young is especially worrying.

Heated tobacco uses real tobacco, whilst vapes contain no tobacco and use liquids instead. With heated tobacco, users insert tobacco sticks into an electronic device that heats them up.

Their main selling point is the absence of tar, which is toxic and causes cancer and other lung diseases.

Marketed as a healthier smoking option, heated tobacco sticks are, however, still a question mark for the international medical community which says more studies about the long-term effects are needed.

According to the World Health Organisation (WHO), there is currently no evidence to demonstrate that heated tobacco is less harmful than conventional tobacco products.

The WHO did concede that “some independent studies showed significant reductions in the formation of harmful toxins relative to standard cigarettes.”

But it then added: “However, the relationship between exposure and health effect is complex and reduced exposure to these harmful chemicals does not mean that they are harmless, nor does it translate to reduced risk in humans”.

A study carried out by independent body “Tobacco Intelligence” showed that in 2022, 28 per cent of Philip Morris’ revenue stemmed from “smoke-free” products produced specifically for Iqos, their increasingly popular line of heated tobacco and electronic cigarette products.

Their products have been approved for use in 50 countries including the US.

“In the past two years, I have sold more tobacco sticks than I could ever have imagined,” Petros Efstathiou, the owner of a corner shop in central Nicosia, told the Cyprus Mail.

“A lot of people that have come to get their smokes here regularly have switched from traditional smoking to other heated devices recently.”

With younger generations progressively less inclined to smoke ‘traditional’ cigarettes, especially ready-made ones – less so when it comes to rolling tobacco – heated tobacco smoking and vaping is gradually becoming the preferred choice for first-time smokers.

“In particular young people seem to be more drawn to it. When I started selling tobacco sticks, I was quite pessimistic. I thought they would either fade completely or remain the preferred choice of just a few people,” he said.

“Two years later, their popularity has grown massively, much more than I had anticipated. And bear in mind, they are not cheap since a pack of 20 sticks costs €4.”

“The most worrying thing for me is that such devices and alternative smoking methods have changed people’s perceptions regarding the risks,” Dr Violeta Talou, a pulmonologist cooperating with a private clinic in Limassol, told the Cyprus Mail.

“The way such devices are marketed, they way the appear to be ‘cool’ and, more dangerously, harmless, make people believe that they choosing a healthy option.

“The reality is different. Heated tobacco is still harmful. Granted, the absence of tar is important, as it eliminates the risk of inhaling even more carcinogenic substances,” she said.

“But I do want to stress that switching to smoking heated tobacco products cannot be considered a healthy move.”

Talou is concerned that not enough medical studies have been either carried out or published. “So we still don’t fully know the entire spectrum of risks they pose.”

Another important aspect to consider is the psychological factor.

“Smoking is more about the gesture than about the actual physical satisfaction,” behavioural psychologist Marzia Menotti told the Cyprus Mail.

“Younger generations in particular are more aware of the health risks posed by smoking. This is a good starting point. Compared to only 20 years ago, young people have more information and more common sense so as to avoid smoking.”

But she warned that smoking is still ‘cool’ and still a powerful social ice-breaker.

“As a result, young generations tend to avoid traditional smoking but consume more heated tobacco products under the impression that they are prioritising their health,” she said. “We need more studies showing the real risks of such products so that people can make better-informed choices.”

The same thing, she said, goes for vaping.

Vaping is also on the rise, particularly when it comes to disposable devices readily available at every corner shop.

“They go like hot cakes,” Efstathiou confirmed. “I recently had to order more because we would sell out every week.”

The risks posed by vaping are also still being studied by various health bodies around the world.

“The chemicals used in vapes are a matter for concern. And the fact that their sale is mostly unregulated raises several questions,” Talou said.

“Vaping might not present the same risks as traditional smoking, but there are still risks. And, unfortunately, we still don’t know exactly what they are.”