Use of Multiple Tobacco and Tobacco-Like Products Including Heated Tobacco and E-Cigarettes in Japan: A Cross-Sectional Assessment of the 2017 JASTIS Study.

Takefumi Sugiyama,Takahiro Tabuchi

doi:10.3390/ijerph17062161

Abstract

Information on the use of multiple tobacco and tobacco-like products (hereafter multiple tobacco products use, i.e., use of more than one product) is important for tobacco control. Use of heated tobacco products (HTPs), which first became popular in Japan, has been spreading over the world, while information about use of multiple tobacco products, including HTPs, is insufficient. We analyzed data of 10,114 responders from the 2017 Japan “Society and New Tobacco” Internet Survey (JASTIS) study. The prevalence and adjusted odds ratio (aOR) of multiple tobacco products use were estimated with inverse probability weighting using multivariable logistic regression models to approximate the results to whole Japanese estimates. Tobacco and tobacco-like products included cigarettes, cigars, e-cigarettes, HTPs, pipes/water pipes, and smokeless tobacco products. Among Japanese adults, 18.4% were single tobacco product users and 3.2% were multiple tobacco product users in 2017. Among current product users (100%), cigarettes were the most popular product in single (78.8%) and multiple (14.2%) tobacco products use, while HTPs were the second most popular product in single (5.2%) and multiple (10.6%) tobacco products use. People with no perception of risk regarding e-cigarettes/HTPs were more likely to use multiple tobacco products (aOR = 1.47, 95% CI = 1.12–1.92) than those who perceived a risk. Prevalence rates and predictors of multiple tobacco products use, including HTPs, were studied first. In multiple tobacco products use, high popularity of HTPs among current product users was revealed. Risk perception of e-cigarettes/HTPs was associated with multiple tobacco products use. This study provides baseline information on multiple tobacco products use in Japan, which will enable the examination of trends in the future.

Highlights

Cigarette smoking is a major cause of preventable diseases but remains popular throughout the world, despite the decline in prevalence in many countries [1]
In terms of multiple tobacco products use, 3.2% currently used multiple tobacco products; 2.6% currently used dual products; 2.5% currently used dual products including cigarettes; 1.6% currently used both cigarettes and heated tobacco products (HTPs); 0.6% currently used both cigarettes and e-cigarettes; and 0.6% currently used more than two products
Compared with those who perceived a risk in using e-cigarettes/HTPs, the odds of multiple tobacco products use were significantly higher for those who perceived no risk in using e-cigarettes/HTPs

Summary

Introduction

Cigarette smoking is a major cause of preventable diseases but remains popular throughout the world, despite the decline in prevalence in many countries [1]. Novel tobacco and tobacco-like products, such as heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes), have been aggressively marketed [2,3,4]. With the increasing number of new products available to the public, the landscape of tobacco and tobacco-like products use has changed dramatically. E-cigarettes have become increasingly popular in the US while the prevalence of cigarette smoking is decreasing [5]. Res. Public Health 2020, 17, 2161; doi:10.3390/ijerph17062161 www.mdpi.com/journal/ijerph

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