Special Issue "Japan: Evaluating the Effectiveness of Tobacco Control Policies and the Use of Heated Tobacco Products"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 September 2020).

Special Issue Editors

Dr. Shannon Gravely
Website
Guest Editor
Research Assistant Professor & World Heart Federation Emerging Leader for Non-Communicable Disease Prevention
Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
Interests: tobacco control; global health policy; health policy evaluation; harm reduction; regulatory policies for tobacco and cannabis; public health; alternative nicotine/tobacco products
Shannon Gravely, Ph.D., is a Research Assistant Professor within the International Tobacco Control Policy Evaluation Project (the ITC Project) in the Department of Psychology at the University of Waterloo. The ITC Project conducts rigorous evaluation studies of the tobacco control policies and regulations of the WHO Framework Convention on Tobacco Control (FCTC) across 29 countries. Dr. Gravely’s role in tobacco control research within the ITC Project is in systematic evaluation of key tobacco control policies at the population level. She is involved in the development and implementation of international research studies including cohort surveys, data analyses and dissemination of research findings. Her research includes examining the impact of policies in several domains of the FCTC, including health warnings, smoke-free policies, cessation (particularly the role nicotine vaping products may play in harm reduction) and plain packaging. Her research interests also include studies on how cannabis regulatory policies may play a role in problematic patterns of cannabis and tobacco use, whether cannabis legalization is associated with an increase in co-use of cannabis and tobacco and whether cannabis legalization results in a decrease in smoking cessation.
Dr. Ryan Kennedy
Website
Guest Editor
Assistant Professor
Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
Interests: Ryan David Kennedy is a tobacco control researcher interested in the role policy plays in addressing the global tobacco epidemic. Kennedy works in low- and middle-income countries through his role with the Institute for Global Tobacco Control. Kennedy works in many regulatory domains, including point-of-sale, health warning labels and clean air laws. Domestically, Kennedy has a program of research with the FDA’s Center for Tobacco Programs, funded through the Hopkins CERSI (Center for Excellence in Regulatory Science and Innovation) working to understand e-cigarette advertising of product features including flavors. Emerging tobacco products including e-cigarettes present interesting public health challenges. Kennedy has a long history of working on clean air issues and has studied tobacco smoke, wood smoke and ambient pollution in numerous settings. Kennedy uses a variety of research methods including observational studies, surveys, focus groups and key informant interviews.

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue titled “Japan: Evaluating the Effectiveness of Tobacco Control Policies and the Use of Heated Tobacco Products” for the International Journal of Environmental Research and Public Health, a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, we refer you to https://www.mdpi.com/journal/ijerph.

Several countries around the world have implemented strong tobacco control policies in line with the WHO Framework Convention on Tobacco Control (WHO FCTC); however, this has not been the case in Japan. Although Japan ratified the WHO FCTC in June 2004, it has not implemented any of the WHO FCTC policies at the highest level. Among the WHO MPOWER demand-reduction measures (corresponding to WHO FCTC Articles 6, 8, 11/12, and 14), Japan has scored poorly in every category, except for taxes. For example, Japan has among the weakest smoke-free laws in the world (where smoking is allowed in most indoor public venues, including restaurants), small health warnings (30% text warnings), no bans on the use of misleading descriptors such as “light” or “mild”, no laws prohibiting advertising, promotion and sponsorship of tobacco/cigarettes, and only partial coverage for smoking cessation treatments (and no national tobacco cessation strategy).

Relatively few scientific articles have focused on the impact of Japan’s tobacco control efforts, but with more recent possible changes in policies being planned (e.g., smoke-free venues at the 2020 Tokyo Olympic Games), this is an ideal time for research on where Japan stands now in tobacco control policies and on the impact of its tobacco control measures to date.

However, Japan is also noteworthy for another reason. Heated tobacco products (HTPs) have been nationally available for sale since 2016, and while HTPs have been marketed by the tobacco industry in nearly 40 countries since September 2017, these products (particularly Philip Morris’ IQOS) have been embraced most rapidly in Japan, where estimates are that HTPs have replaced nearly one-third of the cigarettes consumed in just three years. Although HTPs are legal, Japan has banned the sale of nicotine-containing e-cigarettes. Given the intensive introduction of HTPs in many countries, there is a need for scientific studies on the impact of HTPs in Japan.

This Special Issue will be a timely and important contribution to our knowledge of the impact of current tobacco control policies, and on the use of heated tobacco products in Japan. We invite the submission of original research articles or systematic reviews with a focus on:

  1. Japan’s current tobacco market landscape and policies/regulations on cigarettes and/or HTPs (and other noncigarette tobacco/nicotine products);
  2. Prevalence and/or consumption of tobacco products (e.g., cigarettes, heated tobacco products): patterns of use, reasons for use, relationship between the use of HTPs and cigarettes;
  3. Effectiveness of Japan’s tobacco control policies (e.g., health warnings, smoke-free, taxes, product regulation);
  4. Economic analyses on the substitutability of HTPs and cigarettes;
  5. Product analyses of emissions, biomarkers of HTPs from Japan, including especially studies that compare HTPs to cigarettes and possibly to e-cigarettes;
  6. Impact of tobacco industry marketing in Japan for cigarettes and/or HTPs.

The timeline for this Special Issue is on the fast track, with the objective of its publication before the 2020 Japan Olympics in August. Thus, the closing date for submission of papers for this special issue will be 15 March 2020.

Dr. Shannon Gravely
Dr. Ryan Kennedy
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Japan
  • Smoking
  • Tobacco control policies
  • WHO Framework Convention on Tobacco Control (FCTC)
  • Noncombustible tobacco/nicotine products
  • Heated tobacco products
  • Electronic cigarettes
  • Harm reduction

Published Papers (14 papers)

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Open AccessArticle
Exposure Assessment of Environmental Tobacco Aerosol from Heated Tobacco Products: Nicotine and PM Exposures under Two Limited Conditions
Int. J. Environ. Res. Public Health 2020, 17(22), 8536; https://doi.org/10.3390/ijerph17228536 - 18 Nov 2020
Abstract
It is too early to provide a clear answer on the impact of exposure to the second-hand aerosol of heated tobacco products (HTPs) in the planning of policy for smoke-free indoors legislation. Here, we conducted a preliminary study to evaluate indoor air quality [...] Read more.
It is too early to provide a clear answer on the impact of exposure to the second-hand aerosol of heated tobacco products (HTPs) in the planning of policy for smoke-free indoors legislation. Here, we conducted a preliminary study to evaluate indoor air quality with the use of HTPs. We first measured the concentration of nicotine and particulate matter (PM2.5) in the air following 50 puffs in the use of HTPs or cigarettes in a small shower cubicle. We then measured these concentrations in comparison with the use equivalent of smoking 5.4 cigarettes per hour in a 25 m3 room, as a typical indoor environment test condition. In the shower cubicle test, nicotine concentrations in indoor air using three types of HTP, namely IQOS, glo, and ploomTECH, were 25.9–257 μg/m3. These values all exceed the upper bound of the range of tolerable concentration without health concerns, namely 3 µg/m3. In particular, the indoor PM2.5 concentration of about 300 to 500 μg/m3 using IQOS or glo in the shower cubicle is hazardous. In the 25 m3 room test, in contrast, nicotine concentrations in indoor air with the three types of HTP did not exceed 3 μg/m3. PM2.5 concentrations were below the standard value of 15 μg/m3 per year for IQOS and ploomTECH, but were slightly high for glo, with some measurements exceeding 100 μg/m3. These results do not negate the inclusion of HTPs within a regulatory framework for indoor tolerable use from exposure to HTP aerosol, unlike cigarette smoke. Full article
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Open AccessArticle
Awareness of Marketing of Heated Tobacco Products and Cigarettes and Support for Tobacco Marketing Restrictions in Japan: Findings from the 2018 International Tobacco Control (ITC) Japan Survey
Int. J. Environ. Res. Public Health 2020, 17(22), 8418; https://doi.org/10.3390/ijerph17228418 - 13 Nov 2020
Abstract
Japan is one of the world’s largest cigarette markets and the top heated tobacco product (HTP) market. No forms of tobacco advertising, promotion, and sponsorship (TAPS) are banned under national law, although the industry has some voluntary TAPS restrictions. This study examines Japanese [...] Read more.
Japan is one of the world’s largest cigarette markets and the top heated tobacco product (HTP) market. No forms of tobacco advertising, promotion, and sponsorship (TAPS) are banned under national law, although the industry has some voluntary TAPS restrictions. This study examines Japanese tobacco users’ self-reported exposure to cigarette and HTP marketing through eight channels, as well as their support for TAPS bans. Data are from the 2018 ITC Japan Survey, a cohort survey of adult exclusive cigarette smokers (n = 3288), exclusive HTP users (n = 164), HTP-cigarette dual users (n = 549), and non-users (n = 614). Measures of overall average exposure to the eight channels of cigarette and HTP advertising were constructed to examine differences in exposure across user groups and products. Dual users reported the highest exposure to cigarette and HTP advertising. Tobacco users (those who used cigarettes, HTPs, or both) reported higher average exposure to HTP compared to cigarette advertising, however non-users reported higher average exposure to cigarette compared to HTP advertising. Retail stores where tobacco or HTPs are sold were the most prevalent channel for HTP and cigarette advertising, reported by 30–43% of non-users to 66–71% of dual users. Non-users reported similar exposure to cigarette advertising via television and newspapers/magazines as cigarette smokers and dual users; however, advertising via websites/social media was lower among non-users and HTP users than among cigarette smokers and dual users (p < 0.05). Most respondents supported a ban on cigarette (54%) and HTP (60%) product displays in stores, and cigarette advertising in stores (58%). Full article
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Open AccessArticle
Reasons for Regularly Using Heated Tobacco Products among Adult Current and Former Smokers in Japan: Finding from 2018 ITC Japan Survey
Int. J. Environ. Res. Public Health 2020, 17(21), 8030; https://doi.org/10.3390/ijerph17218030 - 31 Oct 2020
Abstract
The market growth of heated tobacco products (HTPs), such as IQOS, Ploom TECH, and glo, has increased dramatically in Japan since 2016. Little is known about the reasons why current and former smokers are using HTPs. The data for this cross-sectional study were [...] Read more.
The market growth of heated tobacco products (HTPs), such as IQOS, Ploom TECH, and glo, has increased dramatically in Japan since 2016. Little is known about the reasons why current and former smokers are using HTPs. The data for this cross-sectional study were from the 2018 (Wave 1) International Tobacco Control (ITC) Japan Survey, a national web-based survey of 4500 people, including 658 current HTP users, of whom 549 were concurrently smoking cigarettes and 109 were former smokers. The most common reasons for regularly using HTPs were: beliefs that HTP are less harmful than cigarettes to themselves (90.6%) or to others (86.7%), enjoyment (76.5%), and social acceptability (74.4%). About half of current smokers (55.1%) reported using HTPs because these products might help them quit smoking. However, a near-equal percentage (52.0%) of current smokers reported using HTPs to replace some of the cigarettes they smoked so that they did not have to give up smoking altogether. If smokers are using HTPs to complement rather than quit their smoking, then the harm reduction potential of HTPs suggested by the toxicity studies will be diminished. Full article
Open AccessArticle
What Is Accounting for the Rapid Decline in Cigarette Sales in Japan?
Int. J. Environ. Res. Public Health 2020, 17(10), 3570; https://doi.org/10.3390/ijerph17103570 - 20 May 2020
Cited by 1
Abstract
This study describes how trends in the sale of cigarettes in Japan between 2011 and 2019 correspond to the sales of heated tobacco products (HTPs) that were introduced into the Japanese market in late 2015. Data used for this study come from the [...] Read more.
This study describes how trends in the sale of cigarettes in Japan between 2011 and 2019 correspond to the sales of heated tobacco products (HTPs) that were introduced into the Japanese market in late 2015. Data used for this study come from the Tobacco Institute of Japan and Philip Morris International. The findings show that the accelerated decline in cigarette only sales in Japan since 2016 corresponds to the introduction and growth in the sales of HTPs. Full article
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Open AccessArticle
Comparing Factors Related to Any Conventional Cigarette Smokers, Exclusive New Alternative Product Users, and Non-Users among Japanese Youth: A Nationwide Survey
Int. J. Environ. Res. Public Health 2020, 17(9), 3128; https://doi.org/10.3390/ijerph17093128 - 30 Apr 2020
Cited by 1
Abstract
The impact of heated-tobacco-products (HTPs) and electronic cigarettes (e-cigarettes) on youth is a controversial public health issue, as it is unknown whether alternative products result in more youth using such products or smoking. In Japan, e-cigarettes with nicotine are prohibited, but e-cigarettes without [...] Read more.
The impact of heated-tobacco-products (HTPs) and electronic cigarettes (e-cigarettes) on youth is a controversial public health issue, as it is unknown whether alternative products result in more youth using such products or smoking. In Japan, e-cigarettes with nicotine are prohibited, but e-cigarettes without nicotine are available. HTPs are marketed as tobacco products. Within this unique context, we aimed to compare any conventional cigarette smokers (including those who also used alternative products) with exclusive users of alternative products and examine factors relating to their use in Japan. In 2017, 22,275 students in grades 7–9 (age 12–15) and 42,142 in grades 10–12 (age 15–18) nationwide were surveyed. Overall, 1.8% were current users of any of the three products over the last month. Multivariable analysis revealed that risk factors for alternative product use were the same as those for cigarette use. Among all users, exclusive new product users were more likely to participate in club activities and intend to continue to higher education; any conventional cigarette users (including those who also used alternative products) were more likely to be exposed to secondhand smoke at home and to drink alcohol. Reducing adult smoking and disseminating health education remain relevant as strategies for preventing adolescents’ future tobacco use. Full article
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Open AccessArticle
Survey Methods of the 2018 International Tobacco Control (ITC) Japan Survey
Int. J. Environ. Res. Public Health 2020, 17(7), 2598; https://doi.org/10.3390/ijerph17072598 - 10 Apr 2020
Cited by 2
Abstract
This paper describes the methods of the Wave 1 (2018) International Tobacco Control (ITC) Japan Survey. The respondents were adults aged 20 years and older in one of four user groups: (1) cigarette-only smokers who smoked at least monthly and used heated tobacco [...] Read more.
This paper describes the methods of the Wave 1 (2018) International Tobacco Control (ITC) Japan Survey. The respondents were adults aged 20 years and older in one of four user groups: (1) cigarette-only smokers who smoked at least monthly and used heated tobacco products (HTPs) not at all or less than weekly, (2) HTP-only users who used HTPs at least weekly and smoked cigarettes not at all or less than monthly, (3) cigarette-HTP dual users who smoked at least monthly and used HTPs at least weekly, and (4) non-users who had never smoked or who smoked less than monthly and used HTPs less than weekly. Eligible respondents were recruited by a commercial survey firm from its online panel. Respondents were allocated proportionally to sample strata based on demographic, geographic, and user type specifications benchmarked to a national reference. Survey weights, accounting for smoking/HTP use status, sex, age, education, and geography, were calibrated to benchmarks from a nationally representative survey in Japan. Response rate was 45.1% and cooperation rate was 96.3%. The total sample size was 4615 (3288 cigarette smokers, 164 exclusive HTP users, 549 cigarette-HTP dual users, and 614 non-users). The 2018 ITC Japan Survey sampling design and survey data collection methods will allow analyses to examine prospectively the use of cigarettes and HTPs in Japan and factors associated with the use of both products and of transitions between them. Full article
Open AccessArticle
Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey
Int. J. Environ. Res. Public Health 2020, 17(7), 2394; https://doi.org/10.3390/ijerph17072394 - 01 Apr 2020
Cited by 5
Abstract
In Japan, the tobacco industry promotes heated tobacco products (HTPs) as a reduced-risk tobacco product. This study examines: (1) smokers’ harm perceptions of HTPs relative to combustible cigarettes; (2) differences in relative harm perceptions between exclusive smokers and smokers who use HTPs (concurrent [...] Read more.
In Japan, the tobacco industry promotes heated tobacco products (HTPs) as a reduced-risk tobacco product. This study examines: (1) smokers’ harm perceptions of HTPs relative to combustible cigarettes; (2) differences in relative harm perceptions between exclusive smokers and smokers who use HTPs (concurrent users) and between concurrent users based on frequency of product use; and (3) if smokers who were exposed to HTP advertising hold beliefs that are consistent with marketing messages of lower harmfulness. This cross-sectional study included 2614 adult exclusive cigarette smokers and 986 concurrent users who reported their perceptions of harmfulness of HTPs compared to cigarettes, as well as their exposure to HTP advertising in the last six months. Among all smokers, 47.5% perceive that HTPs are less harmful than cigarettes, 24.6% perceive HTPs to be equally as harmful, 1.8% perceive HTPs as more harmful, and 26.1% did not know. Concurrent users are more likely than exclusive smokers to believe that HTPs are less harmful (62.1% versus 43.8%, p < 0.0001) and less likely to report that they did not know (14.3% versus 29.4%, p < 0.0001). Frequent HTP users are more likely than infrequent users to believe that HTPs are less harmful (71.7% versus 57.1%, p ≤ 0.001). Believing that HTPs are less harmful than cigarettes was associated with noticing HTP advertising on TV (p = 0.0005), in newspapers/magazines (p = 0.0001), on posters/billboards (p < 0.0001), in stores where tobacco (p < 0.0001) or where HTPs (p < 0.0001) are sold, on social media (p < 0.0001), or in bars/pubs (p = 0.04). HTP users were significantly more likely than non-HTP users to believe that HTPs are less harmful than cigarettes, with this belief being more prominent among frequent users. Smokers who have been exposed to HTP advertising were more likely to perceive HTPs as less harmful than cigarettes. Full article
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Open AccessArticle
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
Int. J. Environ. Res. Public Health 2020, 17(6), 2161; https://doi.org/10.3390/ijerph17062161 - 24 Mar 2020
Cited by 1
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 [...] Read more.
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. Full article
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Open AccessArticle
Concurrent Daily and Non-Daily Use of Heated Tobacco Products with Combustible Cigarettes: Findings from the 2018 ITC Japan Survey
Int. J. Environ. Res. Public Health 2020, 17(6), 2098; https://doi.org/10.3390/ijerph17062098 - 22 Mar 2020
Cited by 5
Abstract
Use of heated tobacco products (HTPs) among current smokers is becoming increasingly popular in Japan. This study aims to compare characteristics and tobacco-related behaviors among concurrent users of HTPs and combustible cigarettes (n = 644) with exclusive smokers (n = 3194) [...] Read more.
Use of heated tobacco products (HTPs) among current smokers is becoming increasingly popular in Japan. This study aims to compare characteristics and tobacco-related behaviors among concurrent users of HTPs and combustible cigarettes (n = 644) with exclusive smokers (n = 3194) or exclusive HTP users (n = 164). The secondary aim was to explore heterogeneity within concurrent use subgroups. Data were from Wave 1 of the ITC Japan Survey, a nationally representative web survey conducted from February to March 2018. Concurrent cigarette-HTP users were younger and wealthier than exclusive smokers. However, there were no difference in the frequency of smoking, number of cigarettes per day, and smoking cessation behaviors between the two groups, suggesting that HTPs reinforce nicotine dependence. Compared to exclusive HTP users, concurrent cigarette-HTP users reported higher frequency of non-daily HTP use, and lower number of tobacco-containing inserts per day. Almost all concurrent cigarette-HTP users smoked every day (93.9%); 48.4% both smoked and used HTPs daily (dual daily users, n = 396), while 45.5% were daily smokers and non-daily HTP users (predominant smokers, n = 213). Concurrent user subgroups differed from each other on age, tobacco use behaviors, and quit intention. Alongside heterogeneity between concurrent and exclusive product users, differences across concurrent use subgroups highlight the importance of considering frequency of use in characterizing poly-tobacco users. Full article
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Open AccessArticle
Secondhand Smoke Exposure in Public Places and Support for Smoke-Free Laws in Japan: Findings from the 2018 ITC Japan Survey
Int. J. Environ. Res. Public Health 2020, 17(3), 979; https://doi.org/10.3390/ijerph17030979 - 04 Feb 2020
Cited by 1
Abstract
Comprehensive smoke-free policies such as those called for by the WHO FCTC are the only way to protect the public effectively from the harms of secondhand smoke (SHS), yet Japan has been slow to implement this important health measure. This study examines baseline [...] Read more.
Comprehensive smoke-free policies such as those called for by the WHO FCTC are the only way to protect the public effectively from the harms of secondhand smoke (SHS), yet Japan has been slow to implement this important health measure. This study examines baseline levels of smoking and SHS exposure in public places and support for smoking bans in Japan prior to the implementation of the 2018 national smoke-free law. Data are from the International Tobacco Control (ITC) Japan Wave 1 Survey (Feb–Mar 2018), a web survey of adult cigarette smokers, heated tobacco product users, dual users, and non-users (total N = 4684). Measures included prevalence of smoking (whether respondents noticed people smoking inside restaurants and bars at their last visit, and workplaces in the last month), and support for complete smoking bans in these venues. Smoking prevalence in each venue was high overall in 2018 (49% of workplaces, 55% of restaurants, and 83% of bars), even higher than in China, the country with the greatest toll of SHS. Support for complete smoking bans was very high overall (81% for workplaces, 78% for restaurants, and 65% for bars). Non-users were less likely to be exposed to SHS and had higher support for smoking bans than tobacco users. These findings point to the ineffectiveness of partial smoke-free laws in Japan and reinforce the call for comprehensive smoke-free laws, which even smokers would support at higher levels than in many other ITC countries. Full article
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Open AccessArticle
Effectiveness of Text-Only Cigarette Health Warnings in Japan: Findings from the 2018 International Tobacco Control (ITC) Japan Survey
Int. J. Environ. Res. Public Health 2020, 17(3), 952; https://doi.org/10.3390/ijerph17030952 - 04 Feb 2020
Cited by 1
Abstract
Health warnings are an effective strategy for communicating the health harms of smoking, encouraging quitting, and preventing smoking initiation. This study examines the effectiveness of existing text-only health warnings, identifies key predictors of warning effectiveness, and assesses support for pictorial warnings in Japan. [...] Read more.
Health warnings are an effective strategy for communicating the health harms of smoking, encouraging quitting, and preventing smoking initiation. This study examines the effectiveness of existing text-only health warnings, identifies key predictors of warning effectiveness, and assesses support for pictorial warnings in Japan. Data are from the 2018 International Tobacco Control (ITC) Japan Survey, a cohort survey of adult cigarette smokers (n = 3306), dual users of cigarettes and heated tobacco products (n = 555), and non-cigarette smokers (n = 823). Weighted multivariable logistic regression models were used to assess predictors of warning effectiveness and support for pictorial warnings. Overall, 15.6% of respondents noticed warnings, and 7.9% read or looked closely at warnings. Overall, 10.3% of smokers and dual users said the warnings stopped them from having a cigarette, and 7.2% avoided warnings. Overall, 27.5% of respondents said the warnings made them think about health risks of smoking, but only 2.7% of smokers and dual users said the warnings made them more likely to quit. Overall, 57.6% of respondents supported pictorial warnings. The weak effectiveness of Japan’s text-only warnings is consistent with that in other countries with similar warnings. There is majority support for pictorial warnings in Japan, although the level of support is lower than in other countries. Full article
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Open AccessFeature PaperArticle
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(23), 4630; https://doi.org/10.3390/ijerph16234630 - 21 Nov 2019
Cited by 9
Abstract
Heated tobacco products (HTPs), such as IQOS, glo, and Ploom TECH, with a variety of flavored tobacco-containing inserts, have reportedly achieved a significant market share in Japan. We analyzed data from Wave 1 of the ITC Japan Survey, a nationally representative web survey [...] Read more.
Heated tobacco products (HTPs), such as IQOS, glo, and Ploom TECH, with a variety of flavored tobacco-containing inserts, have reportedly achieved a significant market share in Japan. We analyzed data from Wave 1 of the ITC Japan Survey, a nationally representative web survey conducted in February to March 2018 among 4684 adult participants to estimate the prevalence of HTP use, describe characteristics of HTP users, and explore user preferences for HTP device and flavor. The overall prevalence of monthly HTP use was 2.7% (1.7% daily use). Virtually all HTP users were current cigarette smokers (67.8%) or former smokers (25.0%); only 1.0% of HTP users were never smokers. Among HTP users, IQOS was the most frequently reported brand used (64.5%), and menthol was the most common flavor reported (41.5%). IQOS was used more by younger respondents and those who reported daily use, while Ploom TECH was more popular among older respondents and non-daily HTP users. This is one of the first non-industry funded studies to explore the use of HTPs in Japan. Full article
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Open AccessBrief Report
Estimating the Carcinogenic Potency of Second-Hand Smoke and Aerosol from Cigarettes and Heated Tobacco Products
Int. J. Environ. Res. Public Health 2020, 17(22), 8319; https://doi.org/10.3390/ijerph17228319 - 10 Nov 2020
Abstract
The revised Promotion Act, enforced in April 2020, allows the establishment of dedicated smoking rooms for heated tobacco products (HTPs). Since carcinogenicity assessment is unable to determine the safe level of secondhand smoke, we estimated excess lifetime cancer risk using previously reported risk [...] Read more.
The revised Promotion Act, enforced in April 2020, allows the establishment of dedicated smoking rooms for heated tobacco products (HTPs). Since carcinogenicity assessment is unable to determine the safe level of secondhand smoke, we estimated excess lifetime cancer risk using previously reported risk factors. Assuming that nicotine inhalation is proportional to cancer potency, the lifetime cancer risk for HTP IQOS is expected to be below 10−5 (1/100,000), which is three orders of magnitude lower than that for cigarettes. Full article
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Open AccessBrief Report
Use of Heated Tobacco Products within Indoor Spaces: Findings from the 2018 ITC Japan Survey
Int. J. Environ. Res. Public Health 2019, 16(23), 4862; https://doi.org/10.3390/ijerph16234862 - 03 Dec 2019
Cited by 3
Abstract
Although heated tobacco products (HTPs) have become increasingly popular in Japan, little is known about whether these emerging tobacco products are being used within indoor public spaces. Nationally representative data were obtained prior to implementation of a comprehensive smoke-free law in Japan as [...] Read more.
Although heated tobacco products (HTPs) have become increasingly popular in Japan, little is known about whether these emerging tobacco products are being used within indoor public spaces. Nationally representative data were obtained prior to implementation of a comprehensive smoke-free law in Japan as part of Wave 1 of the International Tobacco Control Japan Survey (February–March 2018). We estimated the weighted prevalence of HTP use within indoor public spaces among tobacco users and compared these to estimates for combustible cigarettes (CCs). Overall, 15.6% of current tobacco users in Japan declared that they used HTPs within indoor public spaces. Any HTP use within indoor public spaces was significantly lower than any CC use (80.1% vs. 96.7%). Dual HTP + CC users reported using CCs more frequently than using HTPs within indoor public spaces (97.7% vs. 76.0%). In conclusion, HTP use is less common than CC use within indoor public spaces. Findings of this study can inform the development of targeted smoke-free policies to benefit public health. Full article
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