Heated tobacco use may not help people quit smoking

A Japanese longitudinal study looked at the behaviors of cigarette smokers and heated tobacco users. It concluded that heated tobacco was ineffective in helping people quit smoking tobacco; it discouraged this method and recommended dispelling misperceptions about it. Heated tobacco may also help ex-smokers to resume smoking tobacco.

Introduced in Japan in 2014, heated tobacco devices have become the second best-selling tobacco product there. Among the forty or so countries where these products are marketed, Japan is at the top and is frequently cited as a model in its communication by the tobacco industry. In this country, heated tobacco is considered by half of smokers as the primary method for quitting smoking tobacco.

A longitudinal study conducted in Japan has, however, debunked the myth, perpetuated by manufacturers, that heated tobacco could be a method for quitting smoking tobacco. Conducted between 2019 and 2021 using an online cohort and three waves of the Japan Society and New Tobacco Internet Survey (JASTIS), the study observed changes in the behavior of smokers, ex-smokers, and users of heated tobacco.[1]. A sample of 7,044 adults aged 20 to 74 who responded to two or three of these survey waves was formed. The probability of quitting smoking traditional cigarettes was estimated from reported intentions to quit smoking these same products in the near future.

The use of heated tobacco would distract from stopping smoking tobacco

The results of the study indicate a prevalence of 17.2 % of cigarette smokers, 9.1 % of heated tobacco users and 6.1 % of users of both products (dual use). Figures comparable to those of other representative studies. Among dual users, 35.4 % of people smoking conventional cigarettes also reported using heated tobacco, while 67 % of heated tobacco users also used smoked tobacco. 42 % of heated tobacco users reported daily use of this product.

Among conventional cigarette smokers who had already followed a validated smoking cessation treatment (medical consultations, nicotine replacement therapy), heated tobacco users showed a lower probability of quitting smoking tobacco for a period of one month or more. Among smokers of more than 20 cigarettes/day, those who used heated tobacco showed a probability of quitting smoking for one month or more significantly lower than those who did not.

Resumption of smoking tobacco among ex-smokers who used heated tobacco

The study also shows that ex-smokers who used heated tobacco were more likely to start smoking conventional cigarettes again at one year of follow-up than those who did not use heated tobacco. The influence of heated tobacco use on the resumption of smoking tobacco was more marked among women, young people aged 20 to 29, with little education, no professional occupation and little or no alcohol consumption.

Ultimately, the authors believe that heated tobacco devices are not effective for quitting smoking tobacco and can lead ex-smokers to start smoking again. They call for these products to be discouraged for quitting tobacco smoking in general and for their use to be discouraged among the public. They consider that these heated tobacco products contravene WHO recommendations and the provisions of the FCTC, in particular by maintaining confusion with electronic cigarettes. Finally, they regret that heated tobacco users struggle to define themselves as tobacco users.

Keywords: Japan, heated tobacco, quitting smoking, resuming smoking, ex-smokers

M.F.

[1] Odani S, Tsuno K, Agaku IT, et al. Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan. Tob Control Epub ahead of print: 28 February 2023. doi:10.1136/tc-2022-057613