Prevalence, Use Behaviors, and Preferences among Users of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey

Sutanto, Edward; Miller, Connor R; Smith, Danielle M.; O’Connor, Richard J.; Quah, Anne C K; Cummings, Michael; Xu, Steve; Fong, Geoffrey T.; Hyland, Andrew; Ouimet, Janine; Yoshimi, Itsuro; Mochizuki, Yumiko; Tabuchi, Takahiro; Goniewicz, Maciej Ł.

doi:10.3390/ijerph16234630

Cited by 67 publications

(61 citation statements)

References 31 publications

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“…Our study did not examine whether HTP users are former or never-smokers who started using HTPs because they believe they are less harmful alternative to cigarettes, or if current smokers want to substitute their cigarettes with a potentially less harmful alternative; however, some research has suggested that HTPs may in fact be barrier to smoking cessation in Japan. For example, despite PMI's claims that most IQOS users are former smokers [16], independent research has shown that the majority of Japanese HTP users do not quit smoking [29][30][31][32]. For example, Xu et al found that, among the reasons for using HTPs cited by Japanese concurrent users, non-quit reasons-to cut down on cigarettes (64.6%) and to not have to give up cigarettes altogether (52.1%)-were mentioned as often as or more often than the desire to quit smoking (55.4%) [33].…”

Section: Discussionmentioning

confidence: 99%

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

Gravely

Fong

Sutanto

et al. 2020

IJERPH

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In Japan, the tobacco industry promotes heated tobacco products (HTPs) as a reduced-risk tobacco product. This study examines: (1) smokers’ harm perceptions of HTPs relative to combustible cigarettes; (2) differences in relative harm perceptions between exclusive smokers and smokers who use HTPs (concurrent users) and between concurrent users based on frequency of product use; and (3) if smokers who were exposed to HTP advertising hold beliefs that are consistent with marketing messages of lower harmfulness. This cross-sectional study included 2614 adult exclusive cigarette smokers and 986 concurrent users who reported their perceptions of harmfulness of HTPs compared to cigarettes, as well as their exposure to HTP advertising in the last six months. Among all smokers, 47.5% perceive that HTPs are less harmful than cigarettes, 24.6% perceive HTPs to be equally as harmful, 1.8% perceive HTPs as more harmful, and 26.1% did not know. Concurrent users are more likely than exclusive smokers to believe that HTPs are less harmful (62.1% versus 43.8%, p < 0.0001) and less likely to report that they did not know (14.3% versus 29.4%, p < 0.0001). Frequent HTP users are more likely than infrequent users to believe that HTPs are less harmful (71.7% versus 57.1%, p ≤ 0.001). Believing that HTPs are less harmful than cigarettes was associated with noticing HTP advertising on TV (p = 0.0005), in newspapers/magazines (p = 0.0001), on posters/billboards (p < 0.0001), in stores where tobacco (p < 0.0001) or where HTPs (p < 0.0001) are sold, on social media (p < 0.0001), or in bars/pubs (p = 0.04). HTP users were significantly more likely than non-HTP users to believe that HTPs are less harmful than cigarettes, with this belief being more prominent among frequent users. Smokers who have been exposed to HTP advertising were more likely to perceive HTPs as less harmful than cigarettes.

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Section: Discussionmentioning

confidence: 99%

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

Gravely

Fong

Sutanto

et al. 2020

IJERPH

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“…40) 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 Another Japanese study compared device preference and showed that IQOS was used more by younger people and those who reported daily use. 41) Dunbar et al 42) reported that among young adults in the United…”

Section: Characteristics Of Heated Tobacco Product Usersmentioning

confidence: 99%

The Impact of Heated Tobacco Products on Smoking Cessation, Tobacco Use, and Tobacco Sales in South Korea

Lee

2020

Korean J Fam Med

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Heated tobacco products (HTPs), a hybrid between conventional and electronic cigarettes, were first launched in South Korea in June 2017. Owing to advertisements stating that HTPs are odorless, tar-free, and less harmful to health, the sales of HTPs have grown quickly enough to account for about 10% of the total tobacco market in a year. HTP use by young, highly educated, and high-income groups had a significant impact on both the overall tobacco market over the past 3 years and the smoking and quitting behaviors of smokers. Based on national smoking rate statistics, tobacco sales trends, and the number of visitors to smoking cessation clinics, the following changes have been identified: (1) The decline in current smoking rates has slowed or rose in some groups. (2) The decline in total cigarette sales has slowed but rose again in the first quarter of 2020. (3) The number of visitors to smoking cessation clinics decreased just after the advent of HTPs. These results may be due to the insufficient support of tobacco regulation policies but also coincide chronologically with the appearance of HTPs in South Korea. It is necessary to investigate the usage rate of various tobacco products, including HTPs and e-cigarettes, to examine the health risks of novel tobacco products and provide accurate information to users and policymakers. Finally, tobacco companies are continuously developing new product concepts to escape the regulation of existing cigarettes; thus, comprehensive management measures for all nicotine-containing products are needed.

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“…Exclusive users of HTPs (n = 164) or cigarettes (n = 3194) were defined as participants who only used one of the two products at least once a month, while concurrent cigarette-HTP users (n = 644) reported monthly use of both HTPs and cigarettes. Detailed questions to ascertain participant status to each tobacco product use category have been described elsewhere [7].…”

Section: User Definitionsmentioning

confidence: 99%

“…The popularity of HTPs among affluent population mirrors the price difference between the two products. The price for a pack of cigarettes and a pack of tobacco-containing inserts for HTPs are comparable (In 2018, the price of a pack of cigarettes was approximately ¥500, similarly, the price of a pack of tobacco containing-inserts for IQOS was approximately ¥500) [7]. However, HTP users need to buy the HTP device which cost ranging from 6 to 18 times the price of a pack of cigarettes [7].…”

Section: Characteristics Of Concurrent Cigarette-htp Usersmentioning

confidence: 99%

“…While a declining trend in smoking prevalence in Japan has been observed in recent years [6], HTP use has grown in popularity [1]. Studies from 2017 and 2018 have estimated about two-thirds of HTP users concurrently smoked cigarettes [1,7]. A higher estimate was reported in South Korea, where 96.2% of current HTP users were also current smokers in 2018 [8].…”

Section: Introductionmentioning

confidence: 99%

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

Sutanto

Miller

Smith

et al. 2020

IJERPH

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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.

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Prevalence, Use Behaviors, and Preferences among Users of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey

Cited by 67 publications

References 31 publications

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

The Impact of Heated Tobacco Products on Smoking Cessation, Tobacco Use, and Tobacco Sales in South Korea

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

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