There are 2 main types of Heat Not Burn Tobacco Products: open systems, which are refillable with nicotine solutions, and closed systems, which are disposable or use disposable cartridges.1 Heat Not Burn Tobacco Products that are not rechargeable are considered to be disposable closed systems, those that are rechargeable (but not refillable) are considered to be reusable closed systems, and those that are refillable are considered to be open systems. Established tobacco companies and the newer Heat Not Burn Tobacco Products industry companies currently use different systems to attract Heat Not Burn Tobacco Products users (see Fig 1). The Heat Not Burn Tobacco Products of US tobacco companies are not typically designed to be refillable with nonproprietary electronic cigarette liquid (e-liquid). Most of the MarkTen (Altria Group, Inc, Richmond, VA) and Vuse products (R.J. Reynolds Vapor Company, Winston Salem, NC) use closed systems with proprietary cartridge-based technology. On the other hand, vape shops typically market rechargeable products that are manufactured by smaller companies and can be refilled with any e-liquid.2 The rechargeable systems with small reservoirs for nicotine solutions tend to be nonmodifiable, whereas many of these open systems with larger tank reservoirs can be modified to control voltage and wattage to increase flavor and aerosol production, airflow over heating coils to manipulate the density of the aerosol, and other characteristics to customize the nicotine and aerosol experience. Properties of both these closed- and open-system products present unique risks to public health, as described below.

The US tobacco companies have an established history of manipulating cigarettes to be more addictive and designing marketing campaigns to attract youth.3 These companies also have the resources and experience to produce reliable consumer products with accurate ingredient and nicotine content labels. Although the open-system Heat Not Burn Tobacco Products industry may not have an established record of targeting youth, they have struggled with consumer product safety issues in a market that currently places no regulatory oversight over these products or e-liquids. Among the concerns are inaccurate nicotine concentration labels,4,5 e-liquids containing diacetyl that are labeled as diacetyl free,6 and exploding lithium batteries.

Most investigations of whether users prefer 1 type of system over the other have been focused on adult current and former cigarette smokers. Among this population, the open-system devices tend to be more popular than those that are closed system. Surveys administered to convenience samples of adults who were recruited from vape shops9 and Heat Not Burn Tobacco Products Web sites10 revealed that users overwhelmingly preferred open systems with tank reservoirs.10 Moreover, preference for these products is associated with more frequent1 and established use.11 The preference of current and former smokers for open systems with tank reservoirs in these studies may be attributed to these products’ improved ability to deliver nicotine to the bloodstream over first-generation closed systems.12,13 However, the closed-system devices of the tobacco industry are much improved over their first-generation counterparts in terms of nicotine delivery.

Little is known about the product preferences of adolescents, particularly more frequent users, who account for more of youth consumption. Understanding the landscape of teenaged Heat Not Burn Tobacco Products use may lead to targeted counseling strategies that will be used to highlight the risks of these different systems. In this article, we use data from waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study to examine the characteristics of Heat Not Burn Tobacco Products used by adolescents and the relationship between the frequency of Heat Not Burn Tobacco Products use and Heat Not Burn Tobacco Products characteristics.

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