Product acceptance and use

Watch Mr. Roulet's presentation:

 

Below is a transcript of the video:

Hello, my name is Steve Roulet, and I’m the Global Head Behavioral Research Insight at Philip Morris International. As my colleagues illustrated previously, minimizing tobacco-related harm at the population level through less harmful alternatives depends not only on the degree of risk reduction of the product, but also on its adoption by smokers. It is important that smokers give up smoking completely, and that the use of the product by non-smokers and ex-smokers is minimized. In the next few minutes, I will present high-level evidence on the acceptance and use of our Tobacco Heating System commercialized under the brand name IQOS (our Tobacco Heating System, THS).

If we look at the population as a whole, in order to maximize public health benefits, smokers who would otherwise continue to smoke need to switch to those alternatives in big numbers while product initiation by nonsmokers needs to be minimized.

Let’s see how our THS compares against this objective using our own as well as external data. First, let’s examine the adoption of heated tobacco products in adults. Or, in other words, are heated tobacco products in general and THS specifically able to transition large numbers of smokers away from combustible cigarette use?

Japan is probably the best place to start for two main reasons:

First, Japan is the country with the highest prevalence of heated tobacco products in the world. It is also the country where our THS was first introduced in late 2014 and remains by far the most popular heated tobacco product.

Second, Japan is one of the few countries, if not the only one, where the public health authorities have recently started measuring prevalence of cigarette smoking separately from the use of heated tobacco products.

The data from the government’s National Health and Nutrition Survey show that while the trend in overall prevalence of tobacco use in Japan remains unchanged, the introduction of heated tobacco products in the Japanese market in 2014 – which were measured for the first time in the national survey separately from cigarettes in 2018 – appears to have contributed to the accelerated decline in combustible cigarette smoking. In fact, Japan’s smoking rate is now among the lowest in the developed world.

Here, the overall tobacco use in 2018 and 2019 is broken down by tobacco product category. The bottom portion of the bar shows the proportion of Japanese adults who only smoke combustible cigarettes. Above are those who only use heated tobacco products and do not smoke. The proportion above are those who use both cigarettes as well as heated tobacco products. And at the top are respondents who selected “other” tobacco use.

The most frequent pattern of use of heated tobacco products in Japan is exclusive use, with over 70% of heated tobacco product users who do not smoke cigarettes any longer. In fact, we observe similar conversion rates in our own post-market surveys not only in Japan, but also in other countries where our heated tobacco product is available.

In less than 6 years since the introduction of the product on the market, the THS was used by more than 17 million adults at the end of 2020. More than 70% of them have stopped smoking and switched to THS.

In conclusion, it appears that the THS has a significant potential in transitioning cigarette smokers away from combustible tobacco use.

Now let’s explore the question of initiation, both in adults as well as in youth. Cross-sectional studies are a key component of Philip Morris International’s post market monitoring and surveillance program. We have been conducting repeated cross-sectional surveys within large national representative samples of randomly selected participants coupled with web-based surveys in THS users since 2016, which is the year the THS reached national distribution in Japan.

This slide shows the rate of initiation of tobacco and nicotine products in the past 12 months prior to the survey in adult never tobacco and nicotine product users in Japan, Italy, and Germany. What we observe is very low to non-existing initiation with the THS on a population level.

A similar picture emerges when looking at the smoking status at the time of starting the usage of THS. Among current THS users who had a history of regular tobacco and nicotine-containing product use, Philip Morris’s cross-sectional data from the THS users sample show that about 98% of current THS users were smoking cigarettes when they started to use THS. In other words, they switched from cigarettes to THS. At the same time, only 1 to 2% of current THS users relapsed or re-initiated tobacco use with the THS.

In conclusion, THS use in adults remains mostly confined to those who were already smoking, while initiation with the THS in nonsmokers and former smokers is very low.

Now, let’s explore the use of the THS among youth. I’d like to emphasize that Philip Morris International has not conducted any studies in youth. Therefore, the data that follows comes from external studies who have examined the question of tobacco product use in youth.

Let’s now take a look at one of the available independent studies. An analysis by Kuwabara et al in Japan shows that the prevalence of use of heated tobacco products was low [among youth]. The study data shows that the prevalence of use of heated tobacco products in the last 30 days [preceding the study] was 0.5% among people aged 12 to 15, and 0.9% among people aged 15 to 18. Similar finding from Germany and Switzerland have been recently published, all indicating a low level of use of heated tobacco product in youth.

In Germany, the analysis by Orth and Merkel shows that the prevalence of ever use of heated tobacco products among youth and young adults is low. In fact, the past 30-day use among 12-17-year olds was almost non-existent. In Switzerland, the analysis by Delgrande et al also shows that the prevalence of use of heated tobacco products was low with a prevalence of heated tobacco product use in the past 30 days study of 1.1% among young people aged 15 years old. In short, external data from Japan, Germany, and Switzerland, shows that the prevalence of use in youth is low.

In conclusion, we have observed that the THS has the potential to transition many adult smokers away from combustible cigarette use, which is the most harmful use of tobacco. These transition patterns are starting to emerge at a population level in Japan, the country with the highest prevalence of heated tobacco product use to date.

Almost every THS user has a history of tobacco or nicotine containing product use before starting using the THS. In fact, THS users rarely initiated or re-started tobacco or nicotine use with heated tobacco products. Publicly available data indicates low prevalence of heated tobacco product use among youth.

Looking ahead, we believe that it is important that research instruments adapt to the new, more complex tobacco and nicotine-containing product environment. It will be very difficult to reach any meaningful conclusions about the impact of new tobacco and nicotine products on public health without properly designed surveys that provide consistent, reliable, and accurate data – in particular prevalence and use patterns data for each tobacco or nicotine containing product category.

For the last half hour, my colleagues and I gave an overview about how a smoke-free product could improve public health. We shared data supporting our view that THS is a better alternative than continuing to smoke. We pointed out that currently available data shows evidence that adult smokers are switching to the THS in large numbers, and that unintended consequences such as initiation and relapse with the THS are minimal.

On behalf of all of us, I would like to thank you for joining us today, and I look forward to the Q&A session.