Background: In recent years, heated tobacco products (HTP) have become accepted alternatives to cigarette smoking in Japan. Although available data suggest that the introduction of HTPs or other smoke-free TNPs has not increased the overall tobacco or nicotine product (TNP) use prevalence in Japan, several concerns persist. For example, that many HTP users may continue to smoke, nicotine-naive populations may start using HTPs, or the use of HTPs may impede complete cessation of nicotine use. Our study addresses these concerns by providing current trend data (2016-2022) on IQOS™, cigarette, and overall TNP use behavior for the general adult Japanese population.
Methods: Repeated cross-sectional surveys were conducted over five study years (2016-2022) in representative samples of the Japanese general adult population covering all of Japan. The study protocol, including the procedures of providing informed consent, were approved by the Hakata Clinic Institutional Review Board (Reference ID: J-186) in Fukuoka, Japan.
Results: Between 2016 and 2022, we observed the following trends in IQOS™, cigarette, and overall TNP use behavior: Prevalence ― while the current use prevalence of combustible TNPs decreased from 17.6% to 12.4%, the use prevalence of smoke-free TNPs increased from 2.9% to 5.6% (including HTPs from 1.9% to 5.4% and IQOS™ from 1.8% to 3.5%). At the same time, the prevalence of overall TNP use remained stable between 18.2% and 18.9% from 2016 and 2019, before it decreased to 15.6% in 2022. Use patterns ― the majority of IQOS™ users were initially smokers, while over time the share of IQOS™ users who smoked continued to decline from 28.4% to 17.3%. History of use ― last year TNP initiation, relapse, and reinitiation with IQOS™ remained low (<1%) and stable over time. Quitting ― among cigarette smokers, the rates of quitting cigarettes (3.4%-3.7%) and quitting all TNPs (2.2%-3.2%) remained stable over time. Among IQOS™ users, both the rates of quitting IQOS™ (9.4%-3.5%) and quitting all TNPs (2.6%-1.5%) slightly decreased over time, which was related to the increased percentage of exclusive IQOS™ users in the sample.
Conclusions: Our data suggest that the shift from combustible to smoke-free TNPs in overall TNP use prevalence in Japan is in line with the principles of tobacco harm reduction because (i) uptake of HTPs did not increase overall TNP use at the population level, instead it appears to have replaced smoking; (ii) nearly all current IQOS™ users were cigarette smokers when they started using IQOS™; (iii) the majority of IQOS™ users did no longer smoke; and (iv) IQOS™ use did not prevent smokers who want to quit cigarettes or all TNPs from doing so.