by Kevin Joseph, Lister Hill Center Intern
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Background
Designed and sold by Philip Morris International (PMI), IQOS is a line of heated tobacco products currently sold in over 60 countries worldwide and a few states in the USA (Tobacco Prevention and Cessation). Per the name, these devices utilize a heated blade or induction system in order to heat tobacco sticks (sold separately from device) rather than burn and combust tobacco, as done in a regular cigarette. According to PMI, the produced aerosol is a healthier alternative to smoking that emits 95 percent less of harmful chemicals released in cigarette combustion; however, PMI reiterates that products are not risk-free or that the reduction in released aerosols corresponds to a 95 percent reduction in risk (Phillip Morris International).
According to data from the Behavioral Risk Factor Surveillance System (BRFSS), an estimated 15.6 percent of Alabamian adults are current smokers as of 2022 (CDC). Among those currently smoking, the American Lung Association notes that an estimated 63 percent have attempted to quit smoking as of 2022, emphasizing the prevalence of unsuccessful cessation attempts (American Lung Association). The American Lung Association notes that cigarette smoke contains over 60 carcinogenic chemicals that are related to lung cancer and subsequent mortality, as well as related chemicals that cause chronic obstructive pulmonary disease (COPD) (American Lung Association). Accordingly, PMI markets the IQOS products as a safer alternative to cigarette smoking (Philip Morris International).
Although the FDA officially voted to support PMI’s claim that IQOS products reduce exposure to harmful cigarette smoke chemicals in 2018, they did not agree to support claims that it was related to a reduction in disease or disease risk. Some critics claimed that studies that PMI had conducted do not sufficiency support the supposed reduced health impact of IQOS products compared to cigarettes; however, some support the IQOS product as a harm reduction device (NPR). However, although IQOS is most intended to be a product for current cigarette smokers, evidence shows that non-smokers in other countries have began to use IQOS products (Tobacco Prevention and Cessation).
The IQOS line was planned to have an expansion in the United States in 2024, which has been delayed (Tobacco Insider). Nonetheless, legislation has been proposed to implement a tax on these heated tobacco sticks, similarly to current taxes on cigarettes and other existing tobacco products.
Proposed Legislation
HB438 of 2024 was introduced by Representative Hollis (D-Birmingham) to amend Alabama tax code to implement a tax for heated tobacco products of 17 cents per single-use consumable unit (tobacco stick) from October 1st, 2024, to September 30th, 2027. For the following two years, the tax would be reduced to 8.5 cents, then to half a cent in 2029. The bill explicitly states that the tax is meant to serve as a tax to the consumer as an additional cost after the sale cost of the heated tobacco product itself. Furthermore, the bill establishes a county-level tax on the heat stick product that would equal half the state tax on cigarette at any given time, if the county already has an existing tax. If a municipality has an existing cigarette tax, the bill allows for the municipality to levy a tax on heated tobacco products of half the existing cigarette tax.
Compared to cigarettes, which have a tax of 3.375 cents per cigarette in Alabama, the initial proposed tax on heat sticks is higher. For one of the tobacco sticks made for an IQOS product, the California Department of Public Health has noted that PMI states that “the experience with IQOS is similar to the one of cigarettes” with a similar number of “puffs” per heat stick (California Department of Public Health). Thus, based on a “puffs per dollar” measure, the heat stick product is more expensive; furthermore, the IQOS device is a separate purchase of around $80-130 USD (Tobacco Prevention and Cessation).
Impact
Although this bill would not per se authorize IQOS and heated tobacco stick products to be sold in Alabama (a regulatory power which lies with the federal Food & Drug Administration), it may open the door to sales going forward.
Heated tobacco products are not prevalent in the United States but are more established in other countries, providing a potential comparison. In both Japan and South Korea, the American Lung Association notes with coauthoring organizations also in opposition to heated tobacco products that, rather than transitioning from cigarette use to heated tobacco product use, relatively more users are using both at the same time (American Lung Association). Considering this along with the FDA’s lack of approval for reduced risk claims, some have questioned PMI’s asserted population health benefits through harm reduction of heated tobacco products.
Concerns also have arisen regarding who the heated tobacco products will be marketed towards. The American Lung Association additionally noted that menthol flavoring utilized in IQOS products often is more palatable to youth who may have never smoked a cigarette before, increasing the risk of nicotine dependence even among non-smokers (American Lung Association).
Next Steps
HB438 was indefinitely postponed after review in the 2024 Regular Session by the Ways and Means General Fund House Committee. However, it is expected to be reintroduced in the 2025 Regular Session. If you want to make your voice heard on this or future legislation, click here to identify your elected officials.
Don’t know what to say? Check out this guide from the American Civil Liberties Union on drafting a letter to your government officials.