Trends in prevalence and patterns of use of a heated tobacco product (IQOSTM) in Japan: A three-year repeated cross-sectional study

Abstract

Background: Numerous smoke-free tobacco or nicotine-containing product (TNP) alternatives have been introduced to support individual- and population-level harm reduction relative to continued cigarette smoking. This article details the nationwide prevalence and patterns of TNP use between 2016 and 2019 in Japan following the commercialization of IQOSTM, a smoke-free heated tobacco product (HTP). Methods: Cross-sectional surveys were conducted over a period of three study years (2016/2017, 2017/2018, and 2018/2019) in representative samples of the Japanese general adult population and samples of Japanese adult IQOS users registered in the IQOS owner database of Philip Morris International’s affiliate in Japan. Results: Across the three study years (Y1-Y3), the prevalence of overall current TNP use (Y1-Y3: 18.5%, 18.9%, and 18.2%) and overall TNP use by age and sex remained similar. However, there was a growing shift from cigarette smoking to smoke-free TNP use across the three study years. While the cigarette smoking prevalence (Y1-Y3: 17.6%, 17.3%, and 16.0%) decreased, the use prevalence of smoke-free TNPs, including the HTP IQOS (Y1-Y3: 1.8%, 3.2%, and 3.3%) and e-cigarettes (Y1-Y3, 0.7%, 1.6%, and 2.0%) increased. At the same time, TNP initiation, TNP relapse, and TNP reinitiation with IQOS were all very low across the three study years. Across Y1-Y3, exclusive use of only one type of TNP (Y1-Y3: 82.3%, 75.0%, and 70.4%) decreased, while dual use of two types of TNPs (Y1-Y3: 14.3%, 17.2%, and 16.7%) increased, and poly-TNP use (Y1-Y3: 2.1%, 6.1%, and 10.0%) increased markedly. Moreover, the majority of adult IQOS users were exclusive IQOS users. Conclusions: These findings suggest that current IQOS use behavior trends are in line with the principles of tobacco harm reduction and that HTPs are effective tools for complementing current tobacco control measures.