Literature review | Harm reduction | Oct 13, 2022

      Why did cigarette sales decline in Japan?

      Scientifically substantiated smoke-free alternatives for adults who would otherwise continue to smoke can play a key role in harm reduction, and the Tobacco Heating System (THS) is our leading smoke-free alternative. Japan is the first country where our THS was launched, and it remains the country with the highest number of heated tobacco product (HTP) users in the world. Here, we examine whether the introduction of HTPs and specifically our THS in Japan resulted in the decline of cigarette sales in Japan.

      Tobacco harm reduction

      Reducing tobacco-related harm at the population level by introducing less harmful smoke-free alternatives depends not only on the reduction in risk to the individual who switches from cigarettes to such a product, but also its adoption by adult smokers. According to the harm reduction equation, the more adult smokers who choose the lower risk options instead of continuing to smoke cigarettes, the bigger the impact on reducing population harm.

      Heated tobacco products, or HTPs, heat the tobacco just enough to release a nicotine-containing tobacco aerosol but without burning the tobacco. Because tobacco is heated and not burned there is no smoke, and the levels of harmful and potentially harmful chemicals in the generated aerosols can be significantly reduced compared to cigarette smoke. Because of this they have the potential to be less harmful compared to continued smoking. Whether this is the case, should be assessed for each particular product.

      The totality of the evidence available today from our rigorous scientific assessment program indicates that switching completely to our Tobacco Heating System (THS), while not risk-free, presents less risk of harm than continued smoking. 

      THS, commercialized as IQOS, has the potential to help adult smokers switch away from combustible cigarettes - the most harmful use of tobacco. In fact, independent studies have explored the relationship between a decline in cigarette sales and the introduction of the THS in Japan from 2014 to 2016.

       

      A 9.5% average annual decline in cigarette sales from 2015 to 2018 in Japan

      The THS was introduced in Nagoya, Japan, in late 2014 as a city-pilot and launched nationwide in 2016. The HTP had a staggered introduction across Japan over time, producing a detailed set of statistics to analyze.

      Following the HTP’s introduction from 2015-2016, cigarette sales began to substantially decline in each of the Japanese regions. Before this nationwide launch, total tobacco sales in Japan declined at a rate of 1.8% on average between 2011 and 2015. After the launch of the HTP in Japan, total tobacco sales continued to follow that same trend. But notably, the sale of cigarettes fell more sharply after the nationwide launch of the HTP: a 9.5% average annual decline from 2015 to 2018.

      In-market sales volume of cigarettes, cigarillos, and HTUs, Japan, 2011-2021 PMI Integrated Report 2021 case study: Association between the introduction of heated tobacco products and declines in cigarette smoking

       

      Researchers working for the American Cancer Society published research in the British Medical Journal’s Tobacco Control. They analyzed per capita cigarette sales data from retailers to examine the cause of the significant decline in cigarette sales. The study covered 11 of Japan’s 12 regions, representing 99% of the country’s population, and 72% of all cigarette sales relative to the data reported by Euromonitor International. The data was collected from retail outlets within these 11 regions based on sales data from 2014 to 2018.

      Besides the launch of the HTP, the authors investigated other potential causes for the decline, such as pricing, stricter regulations, the availability of competing HTPs, or even just chance. To do so, they applied multiple alternative causation models to the sales figures. The researchers determined that those factors were unlikely to be the main causes of the decline in cigarette sales.

       

      THS introduction is the most likely explanation for faster cigarette sales decline in Japan

      The authors concluded that the introduction of the HTP was the most likely explanation for the decline in cigarette sales in Japan. And further, the downward trend of combined tobacco sales continued even after the launch of the HTP. We can interpret this to mean that the launch of this product did not lead to an increase in overall tobacco consumption, and that many smokers, who would have otherwise continued to smoke cigarettes, have switched to the HTP.

      The study only included sales data and, therefore, could not assess risk or harm reduction, the authors noted. But, citing other third-party research, they added, “Studies that examine exposures of known toxins in IQOS aerosol have generally found substantially lower levels than in conventional cigarette smoke.”

      The authors wrote, “Definitively identifying that the introduction of a novel tobacco product is significantly changing the marketplace for tobacco products is important information for policymakers and public health proponents as they consider how to alter existing tobacco control policies to accommodate these new products.”

       

      Another independent study further supports the role of THS in cigarette sales decline in Japan

      An article published by researchers at the Medical University of South Carolina and at the University of Ottawa explored the relationship between the decline in cigarette sales in Japan between 2011 and 2019 and the introduction of HTPs into the Japanese market in late 2015. Data for this study came from the Tobacco Institute of Japan and publicly available data from Philip Morris International (PMI).

      Like the research described above, this study found that the acceleration in the decline in cigarette sales in Japan since 2016 does, in fact, correspond to the 2015 introduction and growth of sales of HTPs in the country. Between 2011 and 2019, overall cigarette sales fell by 38% and total tobacco sales (i.e., combining cigarettes and HTPs) declined by 19%.  Following the introduction of HTPs into the Japanese market between 2016-2019, the annual percent change (APC) for tobacco sales overall was -4.77% between 2011 and 2019 (a negative APC means that the sales dropped over time). However, separating out cigarette only sales from HTP sales revealed a different pattern. The APC for cigarette only sales was -3.10% between 2011 and 2015, and -16.38 % between 2016 and 2019, a significant drop in cigarette sales after the introduction of THS.

      The authors noted that their work did not address whether cigarette smokers were completely substituting one product for another, just that the data indicates that HTPs have accelerated the decline in cigarette sales. In fact, we can better understand product use patterns by examining separate data from the Japanese government’s National Health and Nutrition Survey. This showed that the most frequent pattern of use of HTPs in Japan is exclusive use, with an overwhelming majority of HTP users, 76% in 2019, not reporting any cigarette smoking. The proportion of regular smokers who smoked both cigarettes and HTPs was 6.9% of men and 4.8% of women.