Concurrent Daily and Non-Daily Use of Heated Tobacco Products with Combustible Cigarettes: Findings from the 2018 ITC Japan Survey

Abstract

Use of heated tobacco products (HTPs) among current smokers is becoming increasingly popular in Japan. This study aims to compare characteristics and tobacco-related behaviors among concurrent users of HTPs and combustible cigarettes (n = 644) with exclusive smokers (n = 3194) or exclusive HTP users (n = 164). The secondary aim was to explore heterogeneity within concurrent use subgroups. Data were from Wave 1 of the ITC Japan Survey, a nationally representative web survey conducted from February to March 2018. Concurrent cigarette-HTP users were younger and wealthier than exclusive smokers. However, there were no difference in the frequency of smoking, number of cigarettes per day, and smoking cessation behaviors between the two groups, suggesting that HTPs reinforce nicotine dependence. Compared to exclusive HTP users, concurrent cigarette-HTP users reported higher frequency of non-daily HTP use, and lower number of tobacco-containing inserts per day. Almost all concurrent cigarette-HTP users smoked every day (93.9%); 48.4% both smoked and used HTPs daily (dual daily users, n = 396), while 45.5% were daily smokers and non-daily HTP users (predominant smokers, n = 213). Concurrent user subgroups differed from each other on age, tobacco use behaviors, and quit intention. Alongside heterogeneity between concurrent and exclusive product users, differences across concurrent use subgroups highlight the importance of considering frequency of use in characterizing poly-tobacco users.

Beliefs about the Harmfulness of Heated Tobacco Products Compared with Combustible Cigarettes and Their Effectiveness for Smoking Cessation among Korean Adults

“…Compared with CC-only users, HTP users were more likely to perceive HTPs to be less harmful than CCs. Consistent with these results, a previous study found that HTP-only users and dual users of HTPs and CCs were more likely to believe that HTPs were less harmful to users than CCs, compared with CC-only users [ 16 ]. It is common for some tobacco product users to choose specific products which they perceive as less harmful because of their favorable perceptions towards these products [ 21 , 22 , 23 , 24 ].…”

“…Even though one of the reasons for using HTPs was to stop smoking [ 6 , 12 ], several studies have shown no significant association between the use of HTPs and smoking cessation-related behaviors, including attempts or intentions to quit smoking [ 7 , 15 , 16 ]. Moreover, adolescent HTP users were less likely to become former CC smokers despite multiple attempts at smoking cessation [ 17 ].…”

What Is Accounting for the Rapid Decline in Cigarette Sales in Japan?

“…This study does not address the extent to which individual cigarette smokers are substituting HTPs for conventional cigarettes. A recent study suggests that most HTP users in Japan are also concurrently smoking cigarettes [13]. That said, these data do suggest that in Japan at least, the decline in cigarette sales has been accelerated by the introduction of HTPs.…”

Association between Intention to Quit Cigarette Smoking and Use of Heated Tobacco Products: Application of Smoking Intensity Perspective on Heated Tobacco Product Users

“…There have been numerous studies that evaluate the association between e-cigarette use and intention to quit cigarette smoking, some of which included an in-depth analysis in relation to cigarette-smoking frequency (e.g., daily versus non-daily smoking) [ 16 , 17 ] or daily cigarette consumption (e.g., number of cigarettes smoked per day) [ 18 , 19 ]. Meanwhile, other studies focused on the association between HTP use and intention to quit cigarette smoking [ 20 , 21 , 22 ]. While previous studies of HTPs have considered the association with regard to cigarette-smoking frequency, they have not comprehensively evaluated the influence of cigarette-smoking intensity.…”