Cross-sectional Survey to Assess Tobacco and Nicotine Product Use since the Introduction of Tobacco Heating Products in Japan: Wave 1

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Objective: In this study, we obtained key population-level data on use patterns and behavior relating to tobacco and nicotine products in Japan. Methods: We performed a nationwide cross-sectional survey of the general population in Japan in 2019 to assess use patterns after the introduction of tobacco heating products (THPs). Eligible participants were Japanese residents, aged 20 years or older who consented to complete the survey. Individuals living in institutions were excluded. A 3-stage probability sampling method was applied that was geographically stratified by street blocks proportionate to population density. Respondents self-reported patterns of product use and reasons for THP use. Results: Complete responses were available from 5306 individuals, of whom 933.5 (17.6%) were current users, 984.2 (18.5%) were former users, and 3388.4 (63.9%) were never users of tobacco products (weighted respondent totals). Cigarettes were used by 14.6% of current tobacco product users and THPs by 5.3%. Cigarettes and THPs were used exclusively by 64.5% and 12.2%, respectively, and both were used by 12.7%. The most common reasons reported for THP use were perceived reduction in harm to self and others compared to cigarettes. Conclusions: Whereas the prevalence of cigarette use in Japan is decreasing, THPs seem to be increasingly used as long-term alternatives to cigarette smoking.