Alternative Smoking Products

Heated Tobacco Products (HTPs)

Heated tobacco products (“HTPs”), sometimes marketed as “heat-not-burn” products, heat processed tobacco leaf with battery-powered heating-systems to produce an aerosol, which users inhale into their lung.

HTPs deploy various aerosol-generating mechanisms. Some HTPs heat up specifically designed sticks, plugs, or capsules of processed tobacco. Some work by heating up liquids to produce an aerosol which then passes through a tobacco plug to pick up nicotine and other chemicals (such as flavoring agents) from the tobacco before it is inhaled by the user . Some devices can be used to heat up materials of the user’s own choice e.g. cigarette stick, loose tobacco leaf, herbal leaf, etc.

HTPs are as addictive as conventional cigarettes because they are designed to deliver a similar level of nicotine, and can result in second-hand smoke exposure.

Currently, there are not many studies on HTPs. The available data shows that HTPs release hundreds of chemicals, including cancer-causing agents that are present in cigarettes. Although HTPs release some of these chemicals at a lower level than cigarettes, this does not mean translate to a lower risk because there is no known safe level of exposure for many of these chemicals.

HTPs also release around 80 chemicals that are either unique to HTPs or present at a higher level than in conventional cigarette smoke. Some of these chemicals, such as α,β-unsaturated carbonyl compounds, 1,2-dicarbonyl compounds, furans, and epoxides, have significant toxicity. The impact of these substances on the overall toxicity or short- and long-term health effects is not clear.

Information Sheets:
Heated Tobacco Products—for healthcare professionals

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Waterpipe Smoking

Waterpipe, also known as “shisha” or “hookah”, is a smoking device that utilises a stemmed apparatus to heat and smoke flavoured or non-flavoured tobacco. The tobacco is heated by a burning charcoal to give off smoke which passes through a water bowl and is inhaled by the smoker through the hose of the waterpipe. This smoke contains the combustion products of tobacco, and the charcoal or other heating substances.

Contrary to the belief of many waterpipe smokers, waterpipe smoking is not safer than smoking cigarettes. Even after the smoke has passed through water, it contains numerous toxicants including tar, carbon monoxide, heavy metals, and cancer-causing chemicals . Due to the mode of smoking - including frequency of puffing, depth of inhalation, and length of the smoking session - waterpipe smokers may inhale more toxins than they would when smoking cigarettes. A typical 1-hour waterpipe smoking session exposes the user to 100-200 times the volume of smoke inhaled from a single cigarette! It also results in a carbon monoxide level at least four to five times higher than the amount produced by one cigarette.

Information Sheets:
Waterpipe Smoking

E-cigarettes

E-cigarette is an electronic device that uses electric power to heat a chemical solution (e-cigarette liquid) in a cartridge/tank to emit aerosol. Users inhale through a mouthpiece in a way that simulates the act of cigarette smoking. E-cigarette liquid contains at least a few dozens of chemical compounds, including propylene glycol, glycerin, and other additives. The aerosol emitted by e-cigarettes generally contains harmful chemicals such as flavourants and formaldehyde. Some e-cigarette liquid also contain nicotine, which is addictive.

Studies have now concluded that, in addition to nicotine, most e-cigarette products contain or emit numerous substances which are harmful to health.

In Hong Kong, nicotine-containing e-cigarettes are considered “pharmaceutical products” under the Pharmacy and Poisons Ordinance (Cap. 138). Products which fall within the definition of “pharmaceutical product” must meet the standards of safety, efficacy and quality and be registered with the Pharmacy and Poisons Board before they can be sold or distributed in Hong Kong. Besides, nicotine (except tobacco) is categorised as a Part I poison under Cap.138. Illegal possession or sale of Part I poisons or unregistered pharmaceutical products constitutes an offence. The maximum penalty for each offence on conviction is a fine of $100,000 and two years’ imprisonment.

Evidence on the effect of e-cigarettes on smoking cessation remains inconclusive. Smokers who are attempting to quit should be provided with established smoking cessation aids, including various nicotine replacement therapies, varenicline, and counselling, which are rigorously tested for their safety, quality, and effectiveness.

Information Sheets:
E-cigarette—for healthcare professionals

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