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

Edward Sutanto,Takahiro Tabuchi,Maciej L. Goniewicz,Geoffrey T. Fong,Shannon Gravely,Anne C. K. Quah,James F. Thrasher,Tara Elton-Marshall,Grace Li,Christian Boudreau,Ruth Loewen,Mary E. Thompson,Janine Ouimet,Yumiko Mochizuki,Itsuro Yoshimi,Steve S. Xu

doi:10.3390/ijerph17072394

Abstract

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.

Highlights

Smoked tobacco is the most dangerous and common form of nicotine consumption [1,2]
The current study examined perceptions of harmfulness of heated tobacco products (HTPs) compared to cigarettes among a sample of adult Japanese exclusive smokers and concurrent users of cigarettes and HTPs, finding that about half of smokers perceived HTPs as being less harmful than cigarettes
This study found that nearly half of all smokers believed HTPs to be less harmful than cigarettes

Summary

Introduction

The smoke from cigarettes includes over 4000 chemicals and at least 70 known carcinogens [3]. Tobacco harm reduction is a public health strategy that aims to lower exposure to the toxicants produced by tobacco smoke, by encouraging smokers to completely substitute cigarettes with a less harmful product that can deliver nicotine. Alternative nicotine products, such as e-cigarettes and snus, can effectively deliver nicotine without combustion, and are considered to be less harmful than cigarettes [4,5,6,7]. Heated tobacco products (HTPs) are an example of an alternative tobacco product that has been developed by the tobacco industry and may be potentially less harmful than cigarettes [6,7,10,11,12,13]

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