Abstract
Electronic cigarette (e-cigarette) use has become increasingly widespread throughout the world, including in Japan. However, little is known about how e-cigarettes are used in Japan, a country with heavy restrictions on nicotine-containing e-liquids and/or vaping products. This study examined e-cigarette use (e-cigarette use duration, frequency of use, device type, electrical resistance, nicotine use, favorite e-liquid flavors) among users in Japan, through an online survey using a web-based self-reported questionnaire which included questions about sex, age, combustible cigarette and heated tobacco product (HTP) use behaviors. Of 4689 e-cigarettes users analyzed, 93.5% were men and 52.9% had been using e-cigarettes for 1–3 years. Over 80% used e-cigarettes every day; 62.3% used nicotine liquid, and half of the nicotine liquid users used nicotine salt. The most popular liquid flavor was fruit (prevalence: 68.1%), followed by tobacco (prevalence: 48.4%). While 50.9% were e-cigarette single users, 35.2% were dual users (e-cigarettes and cigarettes or HTPs) and 13.8% were triple user (e-cigarettes, cigarettes and HTPs). This is the first comprehensive survey of Japanese e-cigarette users and our finding suggest more than half use nicotine liquid, although e-cigarettes containing nicotine liquid have been prohibited by the Pharmaceutical Affairs Act since 2010 in Japan. The study also showed 49.1% of participants used cigarettes and/or HTPs concurrently (dual or triple users).
Highlights
Electronic cigarette (e-cigarette) use is a relatively new behavior that has spread rapidly worldwide
The number and variety of e-cigarette brands is large and has been increasing [1,2]. This creates major challenges for e-cigaretterelated research, as (1). there are no standardized assessments; (2). there are more than 2800 different e-cigarette devices from over 450 identified brands; (3). there are over 7700 unique e-liquid flavors [1]
Between 31 January and 31 May 2020, we conducted an online survey of people living in Japan who had used e-cigarette at least ≥1 time
Summary
Electronic cigarette (e-cigarette) use is a relatively new behavior that has spread rapidly worldwide. E-cigarettes are battery-operated devices typically designed to deliver nicotine and other additives to users in an aerosol form. The number and variety of e-cigarette brands is large and has been increasing [1,2]. This creates major challenges for e-cigaretterelated research, as (1). There are more than 2800 different e-cigarette devices from over 450 identified brands; (3). The vaping process (e-cigarette use) differs significantly from traditional smoking and varies among e-cigarette users (vapers). Sub-ohm devices produce large, exhaled vapor clouds, potentially leading to exposure to elevated levels of carbonyls, and induced detrimental effects on lung cells [3,4]
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