Prevalence, Use Behaviors, and Preferences among Users of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Measures
2.2.1. Sociodemographic Variables
2.2.2. Patterns of HTP Use and Cigarette Smoking
2.2.3. HTP Device Brand Preferences
2.2.4. HTP Flavor Preferences
2.3. Statistical Analysis
3. Results
3.1. Prevalence of HTP Use and User Characteristics
3.2. Patterns of HTP Use and Cigarette Smoking
3.3. Device Brand Preference
3.4. Flavor Preference
4. Discussion
4.1. Prevalence and Pattern of HTP Use
4.2. Device Brand Preference
4.3. Flavor Preference
4.4. Study Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A. Survey Weighting for “Less than Weekly, but at Least Once a Month” HTP Users
Appendix B
No | Product Name | Device Brand | Flavor Category |
---|---|---|---|
1 | Marlboro Heatstick Balanced | IQOS | Tobacco |
2 | Marlboro Heatstick Menthol | IQOS | Menthol |
3 | Marlboro Heatstick Mint | IQOS | Menthol |
4 | Marlboro Heatstick Purple Menthol | IQOS | Mentholated fruity |
5 | Marlboro Heatstick Regular | IQOS | Tobacco |
6 | Marlboro Heatstick Smooth | IQOS | Tobacco |
7 | Kent Neostick Bright Tobacco | glo | Tobacco |
8 | Kent Neostick Citrus Fresh * | glo | Mentholated fruity |
9 | Kent Neostick Dark Fresh * | glo | Mentholated fruity |
10 | Kent Neostick Fresh Mix | glo | Menthol |
11 | Kent Neostick Intense Fresh | glo | Menthol |
12 | Kent Neostick Refreshing Menthol | glo | Menthol |
13 | Kent Neostick Regular | glo | Tobacco |
14 | Kent Neostick Rich Tobacco * | glo | Tobacco |
15 | Kent Neostick Smooth Fresh | glo | Menthol |
16 | Kent Neostick Spark Fresh * | glo | Mentholated fruity |
17 | Kent Neostick Strong Menthol | glo | Menthol |
18 | Mevius for Ploom TECH Brown Aroma | Ploom TECH | Coffee |
19 | Mevius for Ploom TECH Cooler Green | Ploom TECH | Mentholated fruity |
20 | Mevius for Ploom TECH Cooler Purple | Ploom TECH | Mentholated fruity |
21 | Mevius for Ploom TECH Red Cooler | Ploom TECH | Mentholated fruity |
22 | Mevius for Ploom TECH Regular | Ploom TECH | Tobacco |
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IQOS | Glo | Ploom TECH | |
---|---|---|---|
Device picture | |||
Manufacturer | Philip Morris International (PMI) | British American Tobacco (BAT) | Japan Tobacco International (JTI) |
First launched | November 2014 | December 2016 | March 2016 |
Type of tobacco inserts | Stick | Stick | Capsule |
Device generations | 1st: IQOS 2nd: IQOS 2.4 3rd: IQOS 3 and IQOS 3 Multi | 1st: glo 2nd: glo Series 2 and glo Series 2 Mini | 1st: Ploom TECH 2nd: Ploom TECH+ and Ploom S * |
Brand name of inserts | Marlboro Heatsticks | Kent Neostick | Mevius for Ploom TECH |
Flavor variety of inserts | Balanced, Menthol, Mint, Purple Menthol, Regular, Smooth | Bright Tobacco, Citrus Fresh, Dark Fresh, Fresh Mix, Intense Fresh, Refreshing Menthol, Regular, Rich Tobacco, Smooth Fresh, Spark Fresh, Strong Menthol | Brown Aroma, Cooler Green, Cooler Purple, Red Cooler, Regular |
Price † | IQOS 2.4: ¥7980 [13] IQOS 3 Multi: ¥8980 [14] Marlboro Heatsticks: ¥500 [12] | glo: ¥2980 [13] glo Series 2: ¥2980 [14] glo Series 2 Mini: ¥3980 [14] Kent Neostick: ¥420 [15] | Ploom TECH: ¥2980 [14] Ploom TECH+: ¥4980 [14] Ploom S: ¥7980 [14] Mevius for Ploom TECH: ¥490 [16] |
Variable | Category | Current HTP User (n = 859) | Exclusive HTP User (n = 170) | HTP User by Smoking Status * | ||
---|---|---|---|---|---|---|
Current Smokers (n = 689) | Former Smokers (n = 115) | Never Smokers (n = 7) | ||||
Weighted % (95% Confidence Interval) | ||||||
Prevalence | 2.7 (2.4–3.0) | 0.9 (0.7–1.1) | 1.8 (1.6–2.1) | 0.7 (0.5–0.9) | 0.02 (0.01–0.06) | |
Demographics | ||||||
Gender | Male | 76.0 (72.0–79.7) | 71.8 (63.5–78.8) | 78.1 (73.3–82.2) | 72.8 (62.9–80.8) | 62.7 (23.0–90.4) |
Female | 24.0 (20.3–28.0) | 28.2 (21.2–36.4) | 21.9 (17.8–26.7) | 27.2 (19.1–37.1) | 37.3 (9.5–77.0) | |
F(1.93, 1551.85) = 0.91; p = 0.400 † | ||||||
Age (years) | 20–29 | 16.6 (13.2–20.7) | 12.9 (7.1–22.3) | 18.4 (14.5–22.9) | 14.8 (7.7–26.6) | - |
30–39 | 26.1 (22.6–29.8) | 22.6 (16.2–30.5) | 27.7 (23.8–32.0) | 21.8 (14.4–31.4) | 47.6 (15.6–81.7) | |
40–59 | 44.0 (39.7–48.3) | 55.7 (46.4–64.6) | 38.4 (34.0–43.0) | 54.4 (43.3–65.2) | 52.4 (18.3–84.4) | |
60 and older | 13.3 (10.6–16.7) | 8.8 (4.7–15.8) | 15.5 (12.2–19.5) | 9.0 (4.3–17.9) | - | |
F(5.23, 4200.06) = 1.72; p = 0.122 | ||||||
Annual Household Income | Low | 15.8 (13.0–19.0) | 14.3 (9.3–21.3) | 16.5 (13.4–20.1) | 14.9 (8.9–23.7) | 11.9 (1.6–53.5) |
Moderate | 22.6 (18.2–26.3) | 19.3 (13.2–27.2) | 24.1 (20.3–28.4) | 19.6 (12.5–29.4) | 10.3 (1.3–49.5) | |
High | 51.0 (46.6–55.3) | 60.6 (51.6–68.9) | 46.5 (41.8–51.2) | 61.3 (50.4–71.1) | 60.4 (24.0–88.0) | |
Refused/Do not know | 10.6 (7.9–14.1) | 5.8 (3.1–10.6) | 12.9 (9.4–17.6) | 4.2 (1.8–9.8) | 17.3 (2.4–64.1) | |
F(5.42, 4351.58) = 2.18; p = 0.048 | ||||||
Education | Low | 25.9 (22.6–29.5) | 24.6 (18.3–32.2) | 26.5 (22.9–30.5) | 21.9 (15.1–30.8) | - |
Moderate | 21.4 (17.8–25.3) | 22.1 (16.3–29.1) | 21.0 (16.7–26.0) | 18.7 (12.6–26.7) | 65.0 (28.2–89.7) | |
High | 51.9 (47.6–56.3) | 52.9 (43.9–61.7) | 51.5 (46.7–56.2) | 58.9 (48.3–68.6) | 35.0 (10.2–71.8) | |
Other/Refused/Do not know | 0.8 (0.4–1.7) | 0.4 (0.1–2.9) | 1.0 (0.4–2.3) | 0.5 (0.1–3.8) | - | |
F(5.53, 4439.27) = 1.63; p = 0.140 | ||||||
Product Use Pattern | ||||||
Frequency of HTP Use | Daily | 63.4 (58.9–67.6) | 88.3 (80.5–93.2) | 51.5 (46.7–56.3) | 86.9 (77.2–92.9) | 100.0 |
Weekly | 16.1 (13.5–19.1) | 9.9 (5.7–16.7) | 19.1 (16.1–22.5) | 10.8 (5.8–19.3) | - | |
Monthly | 20.5 (16.7–24.9) | 1.8 (0.2–11.6) | 29.4 (24.4–34.9) | 2.3 (0.3–14.6) | - | |
F(3.03, 2432.26) = 9.56; p < 0.001 | ||||||
Time to first HTP use | 5 min or less | 15.4 (12.8–18.5) | 17.5 (12.0–24.8) | 14.4 (11.7–17.6) | 15.1 (9.1–23.9) | 42.0 (13.0–77.8) |
6–30 min | 33.8 (29.7–38.1) | 40.9 (32.2–50.1) | 30.4 (62.0–35.1) | 42.6 (32.1–53.7) | 25.4 (3.9–74.1) | |
31–60 min | 15.5 (12.5–19.0) | 18.9 (12.5–27.6) | 13.9 (11.0–17.3) | 19.8 (12.2–30.5) | 10.4 (1.3–49.5) | |
More than 60 min | 32.8 (28.9–37.1) | 20.9 (14.2–29.6) | 38.5 (33.9–43.3) | 20.2 (12.5–31.1) | 22.2 (5.1–60.4) | |
Refused/Do not know | 2.5 (1.3–4.6) | 1.8 (0.2–11.6) | 2.8 (1.6–5.0) | 2.3 (0.3–14.6) | - | |
F(6.27, 5038.00) = 1.91; p = 0.071 | ||||||
Tobacco-containing inserts per day ‡ | 10.0 (2.8–15.0) | 10.0 (5.0–18.0) | 7 (1.4–15.0) | 10.0 (5.0–18.0) | 15.0 (3.0–20.0) | |
Device Brand Preferences | ||||||
Device Brand | IQOS | 64.5 (60.3–68.6) | 74.0 (65.3–81.1) | 60.1 (55.3–64.7) | 74.8 (64.1–83.2) | 100.0 |
glo | 14.4 (11.7–17.5) | 8.2 (4.6–14.2) | 17.2 (13.9–21.2) | 8.9 (4.6–16.5) | - | |
Ploom TECH | 21.1 (17.8–24.8) | 17.8 (11.8–25.9) | 22.7 (18.9–26.9) | 16.3 (9.5–26.4) | - | |
F(3.68, 2921.15) = 2.69; p = 0.033 | ||||||
Flavor Preferences | ||||||
Flavor | Tobacco | 33.7 (29.8–37.7) | 29.3 (21.8–38.1) | 35.7 (31.5–40.2) | 26.8 (18.1–37.6) | 35.0 (10.2–71.8) |
Menthol | 41.5 (37.2–45.9) | 47.5 (38.5–56.7) | 38.6 (34.2–43.3) | 49.2 (38.4–60.2) | 65.0 (28.2–89.7) | |
Mentholated fruity § | 20.0 (16.4–24.1) | 20.3 (13.8–28.9) | 19.8 (15.7–24.5) | 21.0 (13.2–31.7) | - | |
Coffee | 3.1 (1.9–4.9) | 0.9 (0.2–3.9) | 4.1 (2.5–6.7) | 0.8 (0.1–5.5) | - | |
Refused/Do not know | 1.8 (0.9–3.4) | 2.0 (0.6–6.1) | 1.7 (0.7–3.7) | 2.2 (0.6–7.8) | - | |
F(7.47, 5995.58) = 1.16; p = 0.319 |
HTP Device Brand | p-Value * | ||||
---|---|---|---|---|---|
Weighted % (95% Confidence Interval) | |||||
IQO (n = 547) | Glo (n = 131) | Ploom TECH (n = 172) | |||
Product Use Pattern | |||||
Frequency of HTP Use | Daily | 69.6 (63.9–74.7) | 60.1 (48.2–70.9) | 49.1 (39.9–58.3) | 0.004 |
Weekly | 14.8 (11.7–18.7) | 16.0 (10.3–24.1) | 20.2 (14.6–27.3) | ||
Monthly | 15.6 (11.1–21.3) | 23.9 (14.0–37.5) | 30.7 (22.4–40.5) | ||
Time to first HTP use | 5 min or less | 19.2 (15.4–23.6) | 13.9 (8.7–21.4) | 6.2 (3.4–11.2) | 0.001 |
6–30 min | 36.6 (31.3–42.3) | 26.6 (18.9–36.1) | 29.6 (21.5–39.3) | ||
31–60 min | 15.8 (12.1–20.4) | 15.2 (8.5–25.7) | 16.3 (10.3–24.8) | ||
More than 60 min | 26.5 (21.9–31.6) | 40.3 (29.6–52.0) | 46.5 (37.4–55.8) | ||
Refused/Do not know | 1.9 (0.6–5.4) | 4.0 (1.3–11.4) | 1.4 (0.4–4.2) | ||
Tobacco-containing inserts per day † | 10.0 (5.0–18.0) | 10.0 (5.0–15.0) | 1.0 (0.7–5.0) | <0.001 | |
Device Brand | |||||
Reason for choosing specific device brand ‡ | Perceived reduction in health risk compared to smoking | 64.7 (59.2–69.8) | 59.2 (48.4–69.2) | 68.4 (59.2–76.4) | 0.364 |
Price | 18.2 (14.0–23.3) | 37.2 (27.8–47.6) | 35.4 (26.9–44.9) | 0.001 | |
Taste | 43.3 (37.8–49.0) | 36.3 (27.0–46.7) | 48.4 (39.2–57.7) | 0.223 | |
Design | 37.6 (32.1–43.4) | 29.4 (20.1–39.4) | 39.3 (30.7–48.6) | 0.768 | |
Time to heat | 21.7 (17.8–26.2) | 42.0 (31.5–53.3) | 54.0 (44.6–63.1) | <0.001 | |
Advertising | 24.9 (20.8–29.5) | 23.1 (13.6–36.5) | 16.9 (11.4–24.3) | 0.703 | |
Availability | 56.5 (50.7–62.1) | 53.2 (42.1–64.0) | 34.5 (26.4–43.6) | 0.002 | |
Used by friends | 68.1 (62.8–73.0) | 41.4 (31.4–52.2) | 25.8 (18.5–34.8) | <0.001 | |
Endorsement in media | 22.9 (18.2–28.5) | 8.3 (4.8–14.1) | 5.9 (2.9–11.3) | <0.001 | |
Flavor | |||||
Flavor | Tobacco | 37.0 (32.0–42.3) | 28.1 (20.5–37.7) | 29.2 (21.9–37.8) | <0.001 |
Menthol | 52.6 (47.0–58.2) | 51.8 (41.0–62.4) | - | ||
Mentholated fruity § | 9.5 (5.9–15.0) | 19.0 (12.4–28.0) | 54.6 (45.3–63.5) | ||
Coffee | - | - | 15.0 (9.5–22.9) | ||
Refused/Do not know | 0.9 (0.3–3.1) | 1.1 (0.3–4.5) | 1.2 (0.4–3.0) |
IQOS * | Glo † | Ploom TECH ‡ | ||
---|---|---|---|---|
aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | ||
Gender | Male | Ref | Ref | Ref |
Female | 1.14 (0.73–1.78) | 0.96 (0.58–1.60) | 0.84 (0.47–1.51) | |
Age (years) | 20–29 | Ref | Ref | Ref |
30–39 | 0.46 (0.24–0.86) | 1.62 (0.78–3.35) | 2.26 (0.90–5.67) | |
40–59 | 0.36 (0.20–0.66) | 1.35 (0.67–2.71) | 3.79 (1.61–8.92) | |
60 and older | 0.20 (0.09–0.43) | 1.53 (0.55–4.21) | 6.52 (2.44–17.44) | |
Annual Household Income | Low | Ref | Ref | Ref |
Moderate | 0.95 (0.51–1.76) | 1.49 (0.69–3.18) | 0.83 (0.39–1.75) | |
High | 1.49 (0.85–2.61) | 1.10 (0.59–2.08) | 0.55 (0.27–1.11) | |
Refused/Do not know | 1.22 (0.58–2.59) | 1.48 (0.60–3.66) | 0.56 (0.22–1.46) | |
Education | Low | Ref | Ref | Ref |
Moderate | 1.26 (0.76–2.09) | 1.16 (0.61–2.21) | 0.58 (0.32–1.07) | |
High | 0.84 (0.54–1.31) | 0.83 (0.49–1.44) | 1.42 (0.83–2.45) | |
Other/Refused/Do not know | 1.28 (0.16–9.91) | 1.66 (0.16–17.18) | - § | |
Frequency of HTP Use | Daily | Ref | Ref | Ref |
Weekly | 0.61 (0.39–0.95) | 1.08 (0.61–1.93) | 1.89 (1.12–3.17) | |
Monthly | 0.49 (0.29–0.83) | 1.26 (0.62–2.56) | 2.12 (1.19–3.76) |
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Sutanto, E.; Miller, C.; Smith, D.M.; O’Connor, R.J.; Quah, A.C.K.; Cummings, K.M.; Xu, S.; Fong, G.T.; Hyland, A.; Ouimet, J.; et al. Prevalence, Use Behaviors, and Preferences among Users of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey. Int. J. Environ. Res. Public Health 2019, 16, 4630. https://doi.org/10.3390/ijerph16234630
Sutanto E, Miller C, Smith DM, O’Connor RJ, Quah ACK, Cummings KM, Xu S, Fong GT, Hyland A, Ouimet J, et al. Prevalence, Use Behaviors, and Preferences among Users of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey. International Journal of Environmental Research and Public Health. 2019; 16(23):4630. https://doi.org/10.3390/ijerph16234630
Chicago/Turabian StyleSutanto, Edward, Connor Miller, Danielle M. Smith, Richard J. O’Connor, Anne C. K. Quah, K. Michael Cummings, Steve Xu, Geoffrey T. Fong, Andrew Hyland, Janine Ouimet, and et al. 2019. "Prevalence, Use Behaviors, and Preferences among Users of Heated Tobacco Products: Findings from the 2018 ITC Japan Survey" International Journal of Environmental Research and Public Health 16, no. 23: 4630. https://doi.org/10.3390/ijerph16234630