Results from a 2018 cross-sectional survey in Tokyo, Osaka and Sendai to assess tobacco and nicotine product usage after the introduction of heated tobacco products (HTPs) in Japan

Abstract

Background: For novel tobacco products that potentially reduce the risk of tobacco harm, post-market surveillance is important to observe population usage and behaviours associated with everyday use. This pilot study was performed to examine the use of tobacco products in three Japanese urban regions. Methods: This study was a cross-sectional epidemiological survey administered in Sendai, Tokyo and Osaka, Japan, from May 19th to June 25th, 2018. Participants were selected with a three-stage probability random sampling process that first identified primary sampling units, then households and finally individuals. Eligible participants were aged at least 20 years who were willing to participate after information about the study was provided. People younger than 20 years and those living in institutions were excluded. Questionnaires were paper based and administered door to door. Results: Responses were obtained from 4154 participants. Sixty-five percent self-reported being never, 19% current and 16% former users of any tobacco product at the time of the survey. Combustible tobacco products (almost all being cigarette) were used most (16%) followed by HTPs (5%). In the categories of combustible tobacco users and HTP users, 70% and 16%, respectively, used these products exclusively. Dual use was reported by 11% of respondents. Compared with 12 months before the survey, 12% of sole combustible tobacco products users were using HTPs exclusively or as dual users and 6% had quit tobacco products completely; 94% of sole HTP users remained sole users and 4% had quit tobacco products completely; and amongst dual users 12% had reverted to exclusive use of combustible tobacco products, 14% had switched to sole use of HTPs and 4% had quit tobacco products completely.

Modelling the Population Health Impacts of Heated Tobacco Products in Japan

“…Combined surveys carried out in Japan from 2018 to 2019 yielded data from 9,770 respondents [22,20]. These surveys enabled calculation of transitions rates between smoking and THP use except for direct switching from cigarette only use to THP only use and vice versa.…”

A National Cross-Sectional Survey to Assess Tobacco and Nicotine Product Usage Patterns and Behaviour Since the Introduction of Tobacco Heating Products in Japan: Wave 1

“…Based on previous experience and results from the pilot study [Adamson et al 2020], we expected the age groups 20-24 years and 25-29 years to be under-represented in the samples. We therefore oversampled for these age groups by adding a quota to each assigned PSU.…”

“…Participants completed a self-administered paper questionnaire that was provided with instructions for completion. In each survey wave, the study questionnaires were adapted from that used in the pilot study [Adamson et al 2020] to cover adequately topics that emerged or evolved during the study run time and were deemed to be essential to assess tobacco use behaviour (Table 1). The questions regarding smoking/using 1-2 years ago and the amount of use up until 12 months ago were removed and the graphic visualization of the time periods were removed.…”

“…Therefore, the formation of many of the toxicants generated in cigarette smoke is prevented or substantially reduced [Eaton et al 2018;Forster et al 2018;Gale et al 2019;Mallock et al, 2018;Schaller et al 2016;Simonavuicius et al 2019;Smith et al 2016]. Japan, the first country where THPs were successfully introduced in 2014, has shown high levels of acceptance for this product category [Adamson et al 2020;Hair et al 2018]. THPs accounted for 23% of the Japanese tobacco market in 2018 [Greenhalgh 2020].…”

“…A pilot cross-sectional survey was conducted in 2018 across three areas of Japan (Tokyo, Osaka and Sendai) to assess tobacco and nicotine product usage after the introduction of THPs [Adamson et al 2020]. Following successful completion of the pilot, a nationwide three-wave survey was initiated [Adamson et al 2019].…”