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

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

doi:10.3390/ijerph17062098

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.

Highlights

Combustible cigarettes and heated tobacco products (HTPs) are the two most commonly used tobacco products in Japan [1,2,3]
Our study found that concurrent cigarette-HTP users differed from exclusive smokers and exclusive HTP users on a number of measures
Concurrent cigarette-HTP users were younger and wealthier than exclusive smokers, indicating important sociodemographic differences between the two tobacco user groups. This contrasts the findings of an ‘actual use’ study conducted by Philip Morris International in the US, which suggested that uptake of IQOS was more likely among middle-aged smokers than young adults [27]

Summary

Introduction

Combustible cigarettes ( referred to as “cigarettes”) and heated tobacco products (HTPs) are the two most commonly used tobacco products in Japan [1,2,3]. Contemporary HTPs were first introduced in Japan through the launch of IQOS by Philip Morris International in 2014 [1]). Nicotine vaping products (NVPs), which have achieved popularity in many countries, are not common in Japan [5]. 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].

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Conclusion