Prevalence and patterns of tobacco and/or nicotine product use in Japan (2017) after the launch of a heated tobacco product (IQOS®): a cross-sectional study

Abstract

Background: Several smoke-free tobacco and/or nicotine-containing products (TNP) have emerged in recent years to support tobacco harm reduction strategies and reduce individual health risks and population harm relative to continued cigarette smoking. This paper describes the nationwide prevalence and patterns of TNP use in Japan following the commercialization of one such smoke-free TNP, the heated tobacco product IQOS® (Philip Morris International). Methods: We analyzed the first annual data (2016–2017) of two repeated cross-sectional surveys conducted in a representative sample of the Japanese general adult (≥20 years of age) population (N = 4,878) and a sample of adult IQOS users (N = 2,000). We assessed the prevalence of current TNP use according to type of product (cigarettes, IQOS, e-cigarettes, and other TNPs) in the general population and patterns of TNP use in the IQOS user sample. Results: The prevalence of current use across all TNP in the sampled general population was 18.5% (95% confidence interval 17.2–19.5%), with 17.5% (16.4–18.6%) for cigarette smoking and 1.8% (1.4–2.2%) for IQOS use. Regarding the distribution of patterns of use in the IQOS user survey, the majority (63.4% [61.2–65.6%]) were exclusive users of IQOS, followed by 20.6% (18.7–22.5%) of individuals who reported dual use of IQOS and cigarettes. Conclusions: In Japan, cigarette smoking remains the most prevalent way of consuming TNP; however, IQOS is being adopted by a growing number of adult Japanese smokers. These findings serve as baseline data for monitoring trends over time in the use and adoption of potential smoke-free TNP in Japan.

Risk perception of IQOS™ and cigarettes: Temporal and cross-country comparisons

“…1 . The overall study design and detailed description of the RP instrument have been described previously ( Afolalu et al, 2021 ; Cano et al, 2018 ).

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“…The details on sample size calculations for Japan have been described elsewhere ( Afolalu et al, 2021 ). Briefly, an annual sample size of 2000 IQOS TM users was deemed sufficient to estimate a 50% prevalence of combined IQOS TM and TNP use with a 95% CI and a precision of ±2.19% ( Afolalu et al, 2021 ; Lwanga et al, 1991 ).…”

“…The details on sample size calculations for Japan have been described elsewhere ( Afolalu et al, 2021 ). Briefly, an annual sample size of 2000 IQOS TM users was deemed sufficient to estimate a 50% prevalence of combined IQOS TM and TNP use with a 95% CI and a precision of ±2.19% ( Afolalu et al, 2021 ; Lwanga et al, 1991 ). In Germany and Italy, the prevalence of fully converted exclusive IQOS TM users was estimated to be 63.4% from the results of an earlier survey ( Afolalu et al, 2021 ).…”

“…One of the key factors that may promote this transition among adult smokers is relative risk perception (RP). RP is a complex concept that incorporates perceived risk of a TNP to one's health or to others ( Afolalu et al, 2021 ). RP has often been explored in the literature from a clinical standpoint or from an epidemiological perspective as disease risk, yet consumers' RP have rarely been investigated, particularly in relation to novel TNPs such as heated tobacco products ( Afolalu et al, 2021 ).…”

“…RP is a complex concept that incorporates perceived risk of a TNP to one's health or to others ( Afolalu et al, 2021 ). RP has often been explored in the literature from a clinical standpoint or from an epidemiological perspective as disease risk, yet consumers' RP have rarely been investigated, particularly in relation to novel TNPs such as heated tobacco products ( Afolalu et al, 2021 ). Qualitative evidence ( Britton et al, 2016 ; East et al, 2021 ; Evans et al, 2020 ; Tompkins et al, 2021 ) and observational studies have demonstrated that the RP of smoke-free TNPs influences current adult smokers' decision to switch to smoke-free TNPs ( Cox et al, 2018 ; Nyman et al, 2019 ; Yang et al, 2019 ).…”