IQOSTM vs. e-Cigarette vs. Tobacco Cigarette: A Direct Comparison of Short-Term Effects after Overnight-Abstinence

Int J Environ Res Public Health. 2018 Dec 18;15(12):2902. doi: 10.3390/ijerph15122902.


Introduction: Research from Philip Morris International's science division on its Heat-not-Burn product IQOSTM focused on its chemical, toxicological, clinical, and behavioral aspects. Independent research on the experiences and behavioral aspects of using IQOSTM, and how it compares to e-cigarettes, is largely lacking. The current randomized, cross-over behavioral trial tried to bridge the latter gaps. Methods: Participants (n = 30) came to the lab on three consecutive days after being overnight smoking abstinent. During each session, participants used one of three products (cigarette, e-cigarette, or IQOSTM) for five minutes. Exhaled CO (eCO) measurements and questionnaires were repeatedly administered throughout the session. Results: Smoking a cigarette for five minutes resulted in a significant increase of eCO, whereas using an IQOSTM resulted in a small but reliable increase (0.3 ppm). Vaping did not affect eCO. Cigarette craving reduced significantly after product use, with the decline being stronger for smoking than for e-cigarettes or IQOSTM. Withdrawal symptoms declined immediately after smoking or using IQOSTM, and with some delay after vaping. IQOSTM scored higher in terms of subjective reward/satisfaction and was slightly preferred to the e-cigarette. Discussion: Short-term use of IQOSTM has a minimal impact on eCO, is equally effective in reducing cigarette craving and withdrawal symptoms as an e-cigarette, and is slightly preferred.

Keywords: electronic cigarettes; heat-not-burn tobacco products; tobacco harm reduction.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Biomarkers / metabolism
  • Carbon Dioxide / metabolism
  • Craving
  • Cross-Over Studies
  • Electronic Nicotine Delivery Systems*
  • Female
  • Harm Reduction*
  • Humans
  • Male
  • Substance Withdrawal Syndrome
  • Surveys and Questionnaires
  • Tobacco Products*
  • Tobacco Smoking / metabolism
  • Tobacco Smoking / psychology*
  • Vaping / metabolism
  • Vaping / psychology*


  • Biomarkers
  • Carbon Dioxide