With the recent approval of the new tobacco product IQOS for sale in the United States, there are worries that, in the midst of the youth e-cigarette epidemic, yet another nicotine delivery device may be brought to the market.

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The first product of its kind to be sold in the United States, the heat-not-burn device IQOS, was approved for marketing and sale by Philip Morris International in April after an FDA ruling. Instead of burning tobacco like regular cigarettes do, heat-not-burn tobacco products, also known as heated tobacco products, use electronic devices to heat tobacco leaves into an inhalable aerosol.

IQOS is an electronic device, but because the FDA has categorized it as a cigarette, it is governed by all of the same regulations that apply to traditional cigarettes. Although a lot is still unknown about the devices and their potential effects, Philip Morris claims that these products are safer than cigarettes.

These are the top six IQOS-related facts.

1. IQOS and e-cigarettes use different technologies.

Because they use real tobacco rather than the flavored e-liquid that is commonly found in e-cigarettes, heat-not-burn products differ from e-cigarettes. The idea behind heat-not-burn is to simulate the appearance and sensation of smoking a traditional cigarette without releasing smoke into the air.

2. The gadgets do not possess “FDA approval.”

The FDA clarified that even though its ruling “allows the tobacco products to be sold in the United States, it does not mean these products are safe or ‘FDA approved.'”

Two regulatory approvals were applied for by the company to the FDA: one was for the product to be marketed as a new tobacco product (known as a Pre-Market approval), and the other was for the product to be marketed as less harmful than other tobacco products (known as a Modified Risk Tobacco Product approval). The application for pre-market approval is subject to the FDA’s ruling. The device’s ability to be marketed as less harmful than other tobacco products has not been determined by the agency.

3. There is no proof that heated tobacco products are any safer than cigarettes.

Because tobacco releases more than 7,000 chemicals when it burns, or combusts, which are present in cigarette smoke, tobacco companies argue that heat-not-burn products are less dangerous than cigarettes.

Although IQOS is less harmful than cigarettes, according to Philip Morris, several studies found that the company’s own data did not fully support these claims in a journal Tobacco Control issue. According to research, using IQOS can expose users to higher levels of certain toxicants even though its levels may be lower than those of cigarettes in some cases. Similarly, users of IQOS may be at a lower risk for certain diseases but a higher risk for others.

The findings of Philip Morris’ research highlight the misconception that reduced exposure claims equate to reduced harm claims, and that a product’s lack of harmful chemicals does not always translate into lower levels of harm experienced by users.

4. Youth may find IQOS appealing.

Researchers at Truth Initiative® discovered that IQOS’s marketing portrays the product as “sophisticated, high-tech, and aspirational” and as “sleek, exclusive items akin to iPhones,” which may appeal to young adults and children.

The product’s marketing raises special concerns because of the recent JUUL-fueled youth e-cigarette epidemic. The use of e-cigarettes has increased, particularly among youth, the majority of whom have never smoked. In fact, in just one year, from 2017 to 2018, the use of e-cigarettes increased by 78% among high school students and 48% among middle school students. JUUL currently holds three-quarters of the market for e-cigarettes in the United States.

These worries are further supported by a different study that was published in Tobacco Control: “IQOS, marketed in a similar manner, will likely appeal to adolescents, just as e-cigarettes, particularly the JUUL-style, which are promoted with a modern, high-tech image, harm reduction, and “smokeless” messages, appeal to adolescents.”

The FDA is imposing restrictions on how the products are marketed, particularly through websites and social media, and mandating that advertising be directed towards adults in order to prevent youth access to IQOS and exposure to its advertising and promotion.

5. The menthol-infused tobacco cartridges have the potential to enhance the Marlboro brand.

With menthol, a flavor that has been demonstrated to draw in young users and make cigarettes easier to smoke and harder to quit, Philip Morris intends to sell rolls of tobacco that resemble miniature cigarettes, known as HeatSticks. The menthol variant’s impact on the product’s appeal, toxicology, or other health effects was not disclosed by the company in its applications submitted to the FDA.

Philip Morris also intends to sell HeatSticks under the Marlboro brand. By promoting the new gadget under the Marlboro name, Marlboro products—including cigarettes—may become more appealing overall. According to research, teenagers’ top brand preference for cigarettes is Marlboro.

6. The industry is attempting to deal with the growing amount of regulation by releasing these products.

According to commentary in Tobacco Control, tobacco companies are trying to subvert government regulation by framing the industry as part of the solution rather than the problem by using harm reduction claims.

According to the commentary, “[Heated tobacco products] are the latest effort by tobacco companies to adapt to a changing regulatory landscape in order to maintain and expand their customer base amid declining cigarette consumption and declining social acceptability of tobacco use.” “Companies market [heated tobacco products] to increase social acceptability for all their tobacco products where regulations are absent or loopholes exempt [heated tobacco products] from existing regulations.”