Recent Trends in Cigarette and HTP Use in Japan: A Scoping Review

Heated tobacco products (HTPs) are promoted as less harmful than combustible cigarettes but epidemiological evidence is scarce, especially in youth. To investigate the associations of persistent respiratory symptoms with HTP use, cigarette use, and dual use among Hong Kong youth. This was a territorywide cross-sectional school-based survey conducted from October 2018 to July 2019 using an anonymous questionnaire. Schools were randomly invited from a proportionate stratified sample in all 18 districts of Hong Kong. Poisson regression models using generalized estimating equations yielded adjusted prevalence ratios (APRs) of respiratory symptoms in (1) former and current HTP (vs never) users in the whole sample and stratified by cigarette use status and (2) exclusive HTP and dual users vs exclusive cigarette users. Statistical analysis was performed from October 2020 to March 2021. Former and current use of cigarettes, HTPs, e-cigarettes, and other tobacco products. Respiratory symptoms for 3 consecutive months in the past 12 months. The study included 33 627 students with a mean (SD) age of 14.8 (1.9) years; 51.3% (18 171) were boys. Respiratory symptoms were reported by 16.3% (n = 5549) of all students, 29.3% (n = 226) of current users of e-cigarettes, 31.2% (n = 314) of current users of cigarettes, and 33.5% (n = 179) of current users of HTPs. Respiratory symptoms were associated with former (APR, 1.30; 95% CI, 1.06-1.59) and current (APR, 1.59; 95% CI, 1.23-2.06) vs never HTP use and current vs never cigarette use (APR, 1.50; 95% CI, 1.30-1.74) after adjusting for various tobacco use. Associations between respiratory symptoms and current vs never HTP use were observed in never (APR, 1.88; 95% CI, 1.36-2.59) and former (APR, 2.15; 95% CI, 1.12-4.12) cigarette users, but not in current cigarette users (APR, 1.24; 95% CI, 0.97-1.59). Respiratory symptoms were associated with exclusive ever HTP use (APR, 1.46, 95% CI, 1.15-1.86) and ever dual use (APR, 1.29; 95% CI, 1.08-1.54) vs exclusive ever cigarette use. There was no association between exclusive current HTP (vs cigarette) use and respiratory symptoms (1.40; 95% CI, 0.93-2.11). This cross-sectional study found that former and current HTP use were associated with persistent respiratory symptoms among youth, especially among never and former cigarette users. Respiratory symptoms were more prevalent in ever exclusive HTP users and ever dual users than ever exclusive cigarette users. These findings suggest that using HTPs instead of cigarettes may not reduce health risks.

Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.

Heated tobacco products (HTPs) are novel alternatives to conventional cigarettes that heat tobacco leaves to generate nicotine-containing aerosols for inhalation. This study aimed to investigate the association between both conventional cigarette use and HTP use with self-reported frequent headache. Although the association between cigarette smoking and headache has been reported, evidence regarding HTPs remains limited. We utilized data from the Japan Society and New Tobacco Internet Survey, an ongoing internet-based cohort cross-sectional study launched in 2015 to monitor conventional cigarette and HTP use. Participants were recruited from a nationally representative online panel, comprising over 2 million individuals. Among 28,000 respondents in the 2025 wave, we included 23,228 individuals with valid responses. Self-reported frequent headache was defined as responding "occasionally" or "frequently" to the question, "Have you experienced headaches in the past year?" (other options: "never" and "rarely"). We conducted a multivariable analysis adjusting for demographic, socioeconomic, lifestyle, and clinical variables. We then compared the adjusted odds ratios (aORs) of conventional cigarettes and HTP use for the prevalence of self-reported frequent headache. Of the 23,228 participants, 25.5% (5923/23,228) reported headaches. Regarding tobacco use, 12.2% (2823/23,228) were current cigarette users, 31.8% (7393/23,228) were former cigarette users, 56.0% (13,012/23,228) were never cigarette users; 11.6% (2688/23,228) were current HTP users, 10.0% (2326/23,228) were former HTP users, and 78.4% (18,214/23,228) were never HTP users. Multivariable analysis with multiple imputation revealed that current (aOR = 1.71 [95% confidence interval [CI] = 1.44-2.03]) and former (aOR = 1.54 [95% CI = 1.37-1.73]) cigarette use, and current (aOR = 1.15 [95% CI = 1.01-1.32]) HTP use were significantly associated with self-reported frequent headache. Former HTP use was not significantly associated with headache (aOR = 1.09 [95% CI = 0.96-1.24]). Postestimation comparisons indicated a weaker association for HTPs than for cigarettes (current smokers vs. current HTP users: ratio of aORs = 1.48 [95% CI = 1.19-1.84]). Both current and former cigarette use were significantly associated with a higher prevalence of self-reported frequent headache, and current HTP use also showed a modest but significant association. Although HTPs are often perceived as less harmful, they still emit nicotine and other constituents, which may be associated with self-reported frequent headache.

Heated tobacco products (HTP) heat-processed tobacco leaf into an aerosol inhaled by the user. This study assessed prevalence and correlates of HTP awareness, ever use, and current use among US middle and high school students. Data came from the 2019 and 2020 National Youth Tobacco Survey, a cross-sectional survey of US public and private, middle and high school students. HTP awareness, ever use, and current (past 30-day) use were assessed. Weighted prevalence estimates and adjusted prevalence ratios (aPR) were assessed overall and by sex, school level, race/ethnicity, and current other tobacco product use. In 2019, 12.8% (3.44 million) of all students reported HTP awareness, increasing to 19.3% (5.29 million) in 2020 (p < .01). Ever [2019: 2.6% (630 000); 2020: 2.4% (620 000)] and current [2019: 1.6% (420 000); 2020: 1.4% (370 000)] HTP use did not significantly change from 2019 to 2020. Current e-cigarette users were more likely to report ever (2020 aPR = 1.79, 95% CI:1.23, 2.62) or current HTP use (2019 aPR = 5.16, 95% CI: 3.48, 7.67; 2020 aPR = 3.39, 95% CI: 2.10, 5.47) than nonusers. In both years, ever and current HTP use was more likely among current combustible (aPR range = 3.59-8.17) and smokeless tobacco product (aPR range = 2.99-4.09) users than nonusers. HTP awareness increased 51% among US students during 2019-2020; however, HTP use did not significantly change during this period. Students who used other tobacco products were more likely to currently use HTPs. Estimates of HTP awareness and use provided serve as a baseline as future monitoring of these products is warranted. Awareness of heated tobacco products (HTPs) increased among US youth from 2019 to 2020; however, HTP use did not change. These estimates of HTP awareness and use serve as a baseline for future surveillance of these products as their availability in the US increases.

Little is known about media exposures to heated tobacco products (HTPs). In this study, we examined sources of HTP exposure, including from paid and unpaid media and social connections, in relation to HTP use and use intentions. In the fall of 2021, we conducted a cross-sectional survey among adult online panelists (aged 18-45 years) in the US and Israel, oversampling tobacco users. The current study analyzed data from participants who responded to the question about HTP awareness or use (n=2061). Multivariable linear and logistic regression analyses examined the relationship between sources of HTP exposure, HTP use, and use intentions. Among those aware of HTPs, both Israelis and Americans reported past-month HTP media exposure via advertisements (58.2% vs 48.0%), non-advertisement sources (49.7% vs 30.7%), and social connections (51.5% vs 33.6%), respectively. Factors associated with HTP awareness (n=677/2061; 32.9%) included media use frequency (AOR=1.13; 95% CI: 1.01-1.28) and social connections using HTPs (AOR=2.45; 95% CI: 1.92-3.15). Among those aware of HTPs, past-month HTP exposure via digital media advertisements (AOR=2.06; 95% CI: 1.09-3.91) and non-advertising promotion via radio, podcast, movie, television or theatre (AOR=2.30; 95% CI: 1.19-4.44) and websites (AOR=2.36; 95% CI: 1.32-4.21) were associated with current HTP use. Exposure to digital media advertisements (β=0.35; 95% CI: 0.07-0.62) and non-advertising promotion via social media (β=0.62; 95% CI: 0.34-0.91) were correlated with higher use intentions. Having social connections using HTPs was correlated with higher use (AOR=2.21; 95% CI: 1.19-4.11) and intentions (β=0.66; 95% CI: 0.42-0.91). No significant differences were found across countries. Digital media (e.g. online, social media) were particularly salient correlates of HTP intentions and use. Future studies are needed that further examine media exposures to these products, as well as that examine possible regulations to limit HTP promotion via these channels.

Heated tobacco products (HTPs) have become popular recently. People with chronic disease, such as diabetes, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD) and cancer, should quit smoking for treatment and recurrence of tobacco-related diseases. However, they have difficulty in quitting smoking, and they may start HTPs use to quit smoking. The purpose of this study is to examine the use of HTPs in people with chronic disease. We used data from an internet study, the Japan Society and New Tobacco Internet Survey (JASTIS). We analyzed 9,008 respondents aged 15–73 years in 2019 using logistic regression. Current use of tobacco products was defined as use within the previous 30 days. Prevalence of current HTP use including dual use and dual use with cigarettes was 9.0% and 6.1% respectively in total. By disease: hypertension 10.2% and 7.4%, diabetes 15.9% and 12.3%, CVD 19.2% and 15.7%, COPD 40.5% and 33.3%, and cancer 17.5% and 11.9%. Diabetes, CVD, COPD, and cancer were positively associated with current use of HTPs (odds ratios (ORs) and 95% confidence intervals (CIs): 1.48 (1.06, 2.07), 2.29 (1.38, 3.80), 3.97(1.73, 9.11), and 3.58(1.99, 6.44), respectively) and dual use of cigarettes and HTPs (ORs and 95% CIs: 2.23 (1.61, 3.09), 3.58 (2.29, 5.60), 7.46 (3.76, 14.80), and 2.57 (1.46, 4.55), respectively) after adjusting for confounders. People with chronic disease were more likely to use HTPs and HTPs together with cigarettes. Further research on the smoking situation of HTPs in patients with chronic diseases is necessary.

BackgroundWith the use of heated tobacco products (HTPs) becoming more widespread in Japan, interest in the health effects of HTP has grown. Since the majority of HTP users are former smokers, information about the user’s smoking history and health status before HTP use is needed when assessing the health effects of HTP use. The limited epidemiological studies available did not consistently consider this information adequately, therefore we conducted a cross-sectional study investigating the association between HTP use and respiratory chronic diseases and symptoms.MethodsThe questionnaires were sent to a research panel members in Japan via the Internet, and individuals who met the study criteria and were either current exclusive HTP users, current exclusive cigarette users or those had never used tobacco products were selected. Information about the participants’ smoking history and health status before they used HTPs was obtained. The effects of participant smoking history before HTP use and the impacts on outcomes upon switching to HTP were assessed using a logistic regression model. The odds ratio (OR) for current exclusive HTP users relative to never tobacco users was calculated. The OR was calculated under two scenarios, one in which the smoking history was ignored or one in which the smoking history was considered.ResultsOf the participants from whom responses to the questionnaires were obtained, 17,406 participants were included in the analysis. Almost all participating current exclusive HTP users had a history of long-term smoking (mean: 30.8 years), and the occurrence of outcomes both before and after the start using HTP was reported. The ORs, without adjustment and with adjustment for smoking history before HTP use were, 3.23 (95% CI: 1.37–7.61) and 1.85 (95% CI: 0.70–4.89) respectively in COPD, same as other outcomes.ConclusionsThese results suggest that smoking history before HTP using affects the occurrence of outcomes, and underscore the importance of considering smoking history when assessing the health effect of HTP use. Since the duration of HTP use is considerably shorter than that of cigarette use at present, further research, such as follow-up surveys assessing the long-term respiratory effects of HTP use, will be necessary.

The article highlights key features of entheses relevant to understanding psoriatic arthritis (PsA). It is emphasized that entheses are regions of stress concentration and that stress levels are reduced by anatomical adaptations at the insertion site and its adjoining tissues. These adaptations for stress dissipation include fascial expansions, the flaring out of soft tissue as it approaches the enthesis, the reduction of insertional angle changes by pulleys or retinacula, and fibrocartilage buffers near the bony interface. Despite such adaptations, however, microdamage is common at entheses and can be associated with the presence of microscopic cellular infiltrates, including macrophages and lymphocytes that can be seen as a normal age-related finding. Observations pertaining to the close functional interdependence between the enthesis and adjacent synovium have led to the concept of a synovio-entheseal complex, which is important for understanding joint physiology and pathophysiologic mechanisms of synovitis in PsA.

Limited data exist on the awareness, beliefs, and use of heated tobacco products (HTPs). Data from 1583 U.S. adult (age ≥ 21 years) current tobacco users were collected in 2021. Participants self-reported HTP awareness, beliefs, use, and susceptibility, as well as current tobacco product use and sociodemographics. We used weighted logistic and multinomial regression models to explore their associations. Overall, 23.6% were aware of, 8.9% had ever used, and 3.0% currently used HTPs. Younger individuals (vs. 61+ years), those with annual income $50,000+ (vs. <$50,000), and those currently using electronic vaping products (vs. non-users) were more likely to be aware of, to have ever used, and to currently be using HTPs (p < 0.05). Black individuals (vs. White) were more likely to report ever and current HTP use (p < 0.05). Current cigarette smoking was not associated with HTP awareness and use (p > 0.05). Holding favorable HTP beliefs was associated with susceptibility to and more advanced HTP use statuses (p < 0.05). Sociodemographics associated with HTP use may reflect HTP marketing strategies. The lack of association with cigarette smoking suggests HTPs may be unlikely cigarette substitutes. Addressing favorable HTP-related beliefs may prevent dual use.

Despite the increased heated tobacco product (HTP) marketing in the United States, little is known about HTP perceptions and correlates of HTP use and use intentions among young adults. Using 2020 cross-sectional data from 2,470 young adults (ages 18-34) from 6 US metropolitan areas, we conducted exploratory factor analysis to identify factors regarding perceived utility/appeal of HTPs, specifically IQOS, and examined these factors in relation to lifetime HTP use and use intentions, using multivariable logistic and linear regression, respectively. 19.1% had heard of HTPs and 4.1% ever used HTPs; 14.7% had heard of IQOS specifically and 2.8% were ever-users. Use intentions were low (M = 1.27, scale: 1 = not at all to 7 = extremely). Factor analysis identified five perceived utility/appeal factors: innovation (M = 3.17, scale: 1 = not at all to 7 = extremely), cigarette substitute (M = 2.99), and youth appeal (M = 2.82), e-cigarette/nicotine substitute (M = 2.36), and fashionable (M = 2.04). Controlling for sociodemographics and other tobacco use, perceiving IQOS as more fashionable and e-cigarette substitutes positively correlated with lifetime HTP use (aOR = 1.60, 95%CI = 1.17, 2.17; aOR = 1.48, 95%CI = 1.11, 1.97, respectively) and use intentions (β = 0.26, 95%CI = 0.21, 0.30; β = 0.14, 95%CI = 0.09, 0.18); perceiving IQOS as cigarette substitutes negatively correlated with ever use (aOR = 0.74, 95%CI = 0.56, 0.97) and use intentions (β = -0.06, 95%CI = -0.10, -0.03). Correlation patterns were similar among past-month cigarette, e-cigarette, and any-tobacco users. Although HTP awareness and use were low, monitoring HTP perceptions and reasons for use as HTPs become more prominent is critical in anticipating their potential impact, particularly as more products seek FDA authorization to use reduced risk or exposure marketing claims. Awareness, ever use, and intentions to use heated tobacco products (HTPs) were low among US young adults in 2020. Perceiving IQOS as fashionable and an e-cigarette substitute were positively correlated with ever use and intention to use HTPs. In addition, perceiving IQOS as a cigarette substitute was negatively correlated with ever use of HTPs and HTP use intentions. Continued surveillance on perceptions and use behaviors is needed to better understand use patterns, intentions to use, and reasons for using HTPs.

INTRODUCTIONThere is growing public health concern about adolescent use of heated tobacco products (HTPs) after the US Food and Drug Administration approved the leading HTPs, IQOS, as a modified risk tobacco product. Extending the previous studies examining the correlates of HTP use among adolescents, this study aims to investigate potential risk factors for HTP use among US adolescents, including the use of multiple tobacco and flavored tobacco products.METHODSWe analyzed the 2019 National Youth Tobacco Survey (n=19018) and conducted a series of logistic regression models on awareness and use of HTPs as a function of tobacco use status (none, single, dual/poly) and past 30 days flavored tobacco use (e.g. menthol cigarette use, flavored e-cigarettes), controlling for sociodemographics.RESULTSIn multivariable analyses, awareness of HTPs was associated with usual menthol cigarette use (AOR=1.77; 95% CI: 1.23–2.53) and past 30 days flavored tobacco use (AOR=1.44; 95% CI: 1.16–1.80). Risk factors for ever HTP use included single (AOR=2.52; 95% CI: 1.19–5.33) and dual/poly tobacco use (AOR=4.94; 95% CI: 2.56–9.54), usual menthol cigarette use (AOR=2.50; 95% CI: 1.66–3.76), and past 30 days flavored tobacco use (AOR=1.61; 95% CI: 1.07–2.44). Risk factors for current HTP use included single (AOR=10.84; 95% CI: 6.72–17.49) and dual/poly tobacco use (AOR=31.96; 95% CI: 17.79–57.43), and usual menthol cigarette use (AOR=2.50; 95% CI: 1.63–3.85).CONCLUSIONSThis study documents HTP use in adolescents and contributes insight and urgency into prioritizing at-risk adolescents for interventions, including current users of other tobacco products and flavored tobacco users.

Heated tobacco product use and associated factors among U.S. youth, 2019

<h3>Introduction</h3> Modified risk tobacco product (MRTP) claims for heated tobacco products (HTPs) that convey reduced exposure compared with conventional cigarettes may promote product initiation and transition among young people. We assessed the effects of a hypothetical MRTP claim for HTPs on young adults’ intention and perceptions of using HTPs and whether these effects differed by their current cigarette and e-cigarette use. <h3>Methods</h3> We embedded a randomised between-subjects experiment into a web-based survey administered among a cohort of 2354 Southern California young adults (aged 20–23) in 2020. Participants viewed depictions of HTPs with an MRTP claim (n=1190) or no claim (n=1164). HTP use intention and HTP-related harm and use perceptions relative to cigarettes and e-cigarettes were assessed. <h3>Results</h3> Overall, participants who viewed versus did not view the claim did not differ in HTP use intention (28.5% vs 28.7%) but were more likely to perceive HTPs as less harmful than cigarettes (11.4% vs 7.0%; p&lt;0.001). The experimental effect on HTP use intention did not differ among past 30-day cigarette smokers versus non-smokers (interaction adjusted OR (AOR)=0.78, 95% CI 0.36 to 1.76) but differed among past 30-day e-cigarette users versus non-users (interaction AOR=1.67, 95% CI 1.02 to 2.68). <h3>Discussion</h3> The hypothetical MRTP claim may lower young adults’ HTP harm perceptions compared with cigarettes but may not change HTP use intention overall or differentially for cigarette smokers. The larger effect on HTP use intention among e-cigarette users than non-users raises the question of whether MRTP claims may promote HTP use or HTP and e-cigarette dual use among young e-cigarette users.

INTRODUCTIONElectronic cigarettes (ECs) and heated tobacco products (HTPs) have gained popularity worldwide, despite concerns about their safety. In Italy, updated national data on these devices remain scarce. The aim of this study is to estimate prevalence, patterns, determinants and trends of EC and HTP use among Italian adults in 2024.METHODSA face-to-face cross-sectional survey was conducted in 2024 on a representative sample of 3125 Italian individuals aged ≥15 years. Data were collected through interviewer-administered questionnaires and included self-reported information on conventional cigarette (CC), EC, and HTP use. We used multivariable logistic regression models to assess adjusted odds ratios (AOR) for EC and HTP use, including sex, age, education level, and smoking status as covariates. Trends (2022–2024) were assessed using analogous surveys.RESULTSIn 2024, 2.3% (95% CI: 1.7–2.8) of Italian adults used EC, and 4.5% (95% CI: 3.7–5.2) HTP. Use of both products declined with age (p for trend <0.001). Dual use with CCs was prevalent among EC (87.8%; 95% CI: 80.1–95.4) and HTP (92.5%; 95% CI: 88.1–96.8) users. Compared with current CC smokers, odds of EC and HTP use were lower in never (EC: AOR=0.04; 95% CI: 0.02–0.09; HTP: AOR=0.01, 95% CI: 0.00–0.03) and former smokers (EC: AOR=0.14; 95% CI: 0.04–0.48; HTP: AOR=0.18; 95% CI: 0.08–0.41). Use of HTP increased by 40% over two years (p for trend = 0.085). Use of EC did not substantially change.CONCLUSIONSThe widespread dual use and the increasing prevalence of HTP use in Italy highlight growing public health concerns. Instead of serving as cessation aids for smokers, these devices are frequently used by youth and alongside CCs.

Background Though electronic cigarettes (EC) and heated tobacco products (HTP) are marketed as harm reduction products, the evidence is that like smoking, their use is dangerous for the lung health. Aim To explore the associations between EC and HTP use and major respiratory diseases (RD). Methods Cross-sectional data of adult representative sample from Russian Tobacco Control Policy Evaluation Survey are analysed, based on multistage sampling in 10 Russian regions in 2017-2018, stratified by smoking status: n = 11625: 6569 smokers, 2377 former smokers, 2679 never smokers. Self-reported formerly diagnosed RD as outcome indicators were analysed in relation with ever EC and HTP use, and current EC use, including HTP. Multiple logistic regression is employed; odds ratios (OR) with 95% CI adjusted by smoking status and socio-demographic factors. Results Chronic bronchitis (CB) was reported by 14% respondents, COPD-by 4.3%, asthma-by 3.1%, emphysema-1.5%, lung cancer-1.1%, tuberculosis (TB)-1.3%. Ever EC use was prevalent in 9.3%, HTP use-in 3.3%, and current EC use-in 2.5% of population. The prevalence of ever EC and HTP use and current EC use was higher among current smokers (13%,4.4%,3.5%), compared to former smokers (7.4%,3.4%,3.5%) and never smokers: 2.2%, 0.7% and 0.6% respectively, (p&amp;lt;.001). Ever HTP users had 2.5 times higher chances of CB: OR 2.52(95%CI 1.9-3.3), and 4 times higher chances of COPD: OR3.97(95%CI 2.8-5.7). The risk is even greater in case of dual EC and tobacco use in current smokers: OR 3.0(95%CI 2.2-4.1) and 4.2(95%CI 2.8-6.3) respectively. Current EC use was significantly associated with asthma: OR 2.9(95%CI 1.5-5.8) and OR 5.0(95%CI 2.6-11.3) in current smokers, lung cancer: OR 4.9(95%CI 1.6-14.8) and 7.2(95%CI 1.9-27.4); and TB:OR4.1(95%CI 1.7-11.6) and 5.4(95%CI 1.6-17.9) respectively. Conclusions EC and HTP use independent from smoking may increase the risk for major RD, combined with tobacco smoking the risk of RD is even greater. Key messages The use of Electronic cigarettes and heated tobacco products, independent from smoking, may increase the risk for major respiratory diseases. Prevalence of EC and HTP use is higher among smokers, compared to former and never smokers; combination of EC and HTP use with tobacco smoking makes the risk of respiratory diseases even greater.