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Otsuka Y, Kaneita Y, Itani O, Matsumoto Y, Hatori Y, Imamura S. Awareness, Attitudes, and Concerns Regarding Heated Tobacco Products Among Physicians in Japan. J Epidemiol 2023; 33:441-449. [PMID: 35370227 PMCID: PMC10409525 DOI: 10.2188/jea.je20210470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/13/2022] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND New tobacco products, particularly heated tobacco products (HTPs), have been introduced across several international markets as alternatives to combustible products, such as cigarettes. However, there are limited studies on physicians' perceptions of HTPs. This study analyzes the awareness of HTPs among physicians and assesses their concerns and attitudes toward patients using HTPs. METHODS A self-administered questionnaire was sent to a sample of 7,500 member physicians (6,000 male and 1,500 female) from the Japan Medical Association (JMA). The smoking status of physicians was categorized as never smokers, ever HTP smokers, current HTP smokers, and ever and current smokers of other products. Physicians' awareness and attitudes toward patients using HTPs were analyzed using descriptive statistics. The correlation between the outcomes was examined using logistic regression models, whereas physicians' concerns about HTPs were analyzed using descriptive statistics. RESULTS Data were obtained from 5,492 physicians (21.9% women; aged 60.4; standard deviation, 12.1 years) with a response rate of 74.6%. Overall, 76.7% of the physicians had awareness of HTP, and about half of whom asked patients about using HTPs. Physicians who took longer to discuss cessation were more likely to discourage patient use. Smoking status was associated with discouraging HTP use in patients. Physicians who had experience with HTP use were primarily concerned about the products' long-term safety and less about product regulation. CONCLUSION Japanese physicians do not have sufficient information and knowledge about HTPs. Therefore, evidence-based guidelines are required to support physicians in advising patients against HTP use.
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Affiliation(s)
- Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
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Matsuyama Y, Tabuchi T. Heated tobacco product use and combustible cigarette smoking relapse/initiation among former/never smokers in Japan: the JASTIS 2019 study with 1-year follow-up. Tob Control 2022; 31:520-526. [PMID: 33408121 DOI: 10.1136/tobaccocontrol-2020-056168] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/09/2020] [Accepted: 11/27/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Use of heated tobacco products (HTPs), which were first launched in Japan, has been rapidly spreading worldwide. The present study aimed to investigate whether HTP use was associated with combustible cigarette smoking relapse/initiation among former/never combustible cigarette smokers. METHODS A prospective cohort study was conducted by analysing two waves of data from the Japan 'Society and New Tobacco' Internet Survey. Among the 7766 never/former combustible cigarette smokers who answered the baseline survey in 2019, 5947 (follow-up rate: 76.6%) responded to the follow-up survey in 2020 (age range 18-73 years old; 50.5% men). The association between HTP use and combustible smoking after 1 year was investigated by multivariable logistic regression analysis adjusting for potential confounders. RESULTS Of the respondents, 308 (5.2%) used HTPs at baseline. One year later, 97 (1.7%) non-HTP users and 39 (12.7%) HTP users were smoking combustible cigarettes. Among former smokers who had quit for 1 year or more and among never smokers, HTP use was significantly associated with combustible cigarette smoking 1 year later (OR=2.80, 95% CI 1.42 to 5.52 and OR=9.95, 95% CI 3.39 to 29.16, respectively), while the association was not significant among former smokers who recently quit. CONCLUSION HTP use was associated with relapse/initiation of combustible cigarette smoking after 1 year. The risks of HTP use, including subsequent combustible smoking, should be carefully monitored.
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Affiliation(s)
- Yusuke Matsuyama
- Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Kim CY, Lee K, Lee CM, Kim S, Cho HJ. Perceived relative harm of heated tobacco products and
electronic cigarettes and its association with use in smoke-free
places: A cross-sectional analysis of Korean adults. Tob Induc Dis 2022; 20:20. [PMID: 35280047 PMCID: PMC8859996 DOI: 10.18332/tid/145699] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/14/2021] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) are often considered to be less harmful and safer than combustible cigarettes (CCs). As a result, numerous tobacco product users opt to use e-cigarettes or HTPs as a safer alternative, though the safety of these products is not fully warranted. The present study aimed to assess the various attitudes towards e-cigarettes and/or HTPs among Korean tobacco product users and their associations with the practical use of e-cigarettes and/or HTPs in private or smoke-free public places. METHODS A cross-sectional study using self-administered questionnaires was conducted from March 2019 to July 2019 on 2971 adult tobacco product users. Attitude towards e-cigarettes and/or HTPs, as well as the relative harm perceptions, in association with their practical use in private or smoke-free areas, were also analyzed. RESULTS Among those surveyed, 46.8% were exclusive users (CC-only smokers 23.5%, e-cigarette-only users 10.7%, HTP-only users 12.7%), and 47.6% were poly-users. Compared with non-e-cigarette or non-HTP users, current e-cigarette or HTP users perceived e-cigarettes or HTPs as less harmful than CCs and they were more acceptable to e-cigarettes or HTPs being used indoors. Their positive attitudes were associated with their more frequent use at home or in their car. Less number of participants supported that the government should regulate e-cigarettes or HTPs in the same way as CCs, their attitude being associated with more frequent use in smoke-free public places. CONCLUSIONS E-cigarettes or HTPs users have more positive attitudes toward their tobacco products than non-e-cigarette or non-HTP users. Those with more positive attitudes toward e-cigarettes or HTPs are closely related to their use in smoke-free places.
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Affiliation(s)
- Choon-Young Kim
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kiheon Lee
- Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Cheol Min Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungroul Kim
- Department of Environmental Health Sciences, Soonchunhyang University, Asan, Republic of Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Gallus S, Lugo A, Stival C, Cerrai S, Clancy L, Filippidis FT, Gorini G, Lopez MJ, López-Nicolás Á, Molinaro S, Odone A, Soriano JB, Tigova O, VAN DEN Brandt PA, Vardavas CI, Fernandez E. Electronic cigarette use in 12 European countries. Results from the TackSHS survey. J Epidemiol 2021. [PMID: 34776500 PMCID: PMC10165220 DOI: 10.2188/jea.je20210329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Limited data on electronic cigarette prevalence, patterns and settings of use are available from several European countries. METHODS Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ≥15 years in each country, provided information on electronic cigarette. RESULTS 2.4% (95% confidence interval, CI: 2.2-2.7) of the subjects (2.5% among men and 2.4% among women; 0.4% among never, 4.4% among current- and 6.5% among ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7.2% in England. Of the 272 electronic cigarette users, 52.6% were dual users (i.e., users of both electronic and conventional cigarettes) and 58.8% used liquids with nicotine. In all, 65.1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden, in particular in workplaces (34.9%), and bars and restaurants (41.5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (p for trend <0.001) and higher among individuals with high level of education (p for trend 0.040). Participants from countries with higher tobacco cigarette prices more frequently reported electronic cigarette use (odds ratio 3.62; 95% CI: 1.80-7.30). CONCLUSIONS Considering the whole adult population of these 12 European countries, more than 8.3 million people use electronic cigarettes. The majority of users also smoked conventional cigarettes, used electronic cigarettes with nicotine and consumed electronic cigarettes in smoke-free indoor areas.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | - Chiara Stival
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS
| | - Sonia Cerrai
- Epidemiology and Health Research Lab, Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR)
| | | | | | - Giuseppe Gorini
- Oncologic Network, Prevention and Research Institute (ISPRO)
| | - Maria José Lopez
- Agència de Salut Pública de Barcelona.,Departament de Ciències Experimentals i de la Salut (DCEXS), Universitat Pompeu Fabra.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP).,Sant Pau Institute of Biomedical Research (IIB Sant Pau)
| | | | - Sabrina Molinaro
- Epidemiology and Health Research Lab, Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR)
| | - Anna Odone
- School of Medicine, University Vita-Salute San Raffaele.,Department of Public Health, Experimental and Forensic Medicine, University of Pavia
| | - Joan B Soriano
- Hospital Universitario La Princesa (IISP).,Consortium for Biomedical Research in Respiratory Diseases (CIBERES)
| | - Olena Tigova
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES).,Tobacco Control Research Group, Epidemiology and Public Health Research Programme, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL.,Tobacco Control Unit, WHO collaborating center on tobacco control, Institut Català d'Oncologia-ICO.,School of Medicine and Health Sciences, Campus of Bellvitge, Universitat de Barcelona
| | - Piet A VAN DEN Brandt
- Maastricht University Medical Centre, GROW- School for Oncology and Developmental Biology, Department of Epidemiology.,Maastricht University Medical Centre, CAPHRI- School for Public Health and Primary Care, Department of Epidemiology
| | | | - Esteve Fernandez
- Consortium for Biomedical Research in Respiratory Diseases (CIBERES).,Tobacco Control Research Group, Epidemiology and Public Health Research Programme, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL.,Tobacco Control Unit, WHO collaborating center on tobacco control, Institut Català d'Oncologia-ICO.,School of Medicine and Health Sciences, Campus of Bellvitge, Universitat de Barcelona
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Znyk M, Jurewicz J, Kaleta D. Exposure to Heated Tobacco Products and Adverse Health Effects, a Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6651. [PMID: 34205612 PMCID: PMC8296358 DOI: 10.3390/ijerph18126651] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
Heated tobacco products (HTP) are a form of nicotine delivery intended to be an alternative to traditional cigarettes. HTP tobacco products are sold to consumers as a less harmful alternative to traditional cigarettes, both for users and bystanders. The actual impact of HTP on the health of users and its overall impact on public health is still not fully known. A systematic search of the literature was carried out to identify relevant studies published in English from 2015 to February 2021. The following databases were used: PubMed, Scopus, Elsevier and ClinicalKey. 25 studies (independent and sponsored by the tobacco industry) were considered. The analysis of exposure biomarkers and cardiovascular and respiratory biomarkers showed differences between smokers and people using heated tobacco products. Improvements in clinically relevant risk markers, especially cholesterol, sICAM-1, 8-epi-PGF2α, 11-DTX-B2, HDL and FEV1, were observed compared to persistent cigarette smokers. On the other hand, exposure to IQOS has been reported to alter mitochondrial function, which may further exaggerate airway inflammation, airway remodeling and lung cancer. These products have the potential to increase oxidative stress and increase respiratory tract infections by increasing microbial adherence to the respiratory tract. Our review suggests that HTP products may be products with a reduced risk of chronic diseases, including respiratory and cardiovascular diseases and cancer compared to traditional smoking, although in the case of non-smokers so far, they may pose a risk of their occurrence. Research seems to be necessary to assess the frequency of HTP use and its potential negative health effects.
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Affiliation(s)
- Małgorzata Znyk
- Department of Hygiene and Epidemiology, Medical University of Lodz, 90-647 Lodz, Poland; (J.J.); (D.K.)
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Okubo R, Yoshioka T, Nakaya T, Hanibuchi T, Okano H, Ikezawa S, Tsuno K, Murayama H, Tabuchi T. Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic. J Affect Disord 2021; 287:89-95. [PMID: 33774320 PMCID: PMC9754685 DOI: 10.1016/j.jad.2021.03.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies indicate an urgent need to take action against mental health issues during the COVID-19 pandemic. However, the association between larger-scale environmental factors such as living conditions and mental health problems during the pandemic is currently unknown. METHODS A nationwide, cross-sectional internet survey was conducted in Japan between August and September 2020 to examine the association between urbanization level and neighborhood deprivation as living conditions and COVID-19 case numbers by prefecture. Prevalence ratios (PRs) for severe psychological distress, suicidal ideation, and new-onset suicidal ideation during the pandemic were adjusted for potential confounders. RESULTS Among 24,819 responses analyzed, the prevalence of mental health problems was 9.2% for severe psychological distress and 3.6% for new-onset suicidal ideation. PRs for severe psychological distress were significantly associated with higher urbanization level (highest PR = 1.30, 95% CI = 1.08-1.56). PRs for new-onset suicidal ideation were significantly associated with higher urbanization level (highest PR = 1.83, 95% CI = 1.37-2.45) and greater neighborhood deprivation (highest PR = 1.35, 95% CI = 1.06-1.72). Severe psychological distress and new-onset suicidal ideation were significantly more prevalent when there was higher urbanization plus lower neighborhood deprivation (PR = 1.34 [1.15-1.56], and 1.57 [1.22-2.03], respectively). CONCLUSION These findings suggest that it is not the number of COVID-19 cases by residence area but higher urbanization level and greater neighborhood deprivation (lower neighborhood-level socioeconomic status) that are associated with severe psychological distress and new-onset suicidal ideation during the pandemic. These findings differ in part from evidence obtained before the pandemic.
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Affiliation(s)
- Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, Japan
| | - Tomoya Hanibuchi
- Graduate School of Environmental Studies, Tohoku University, Sendai, Miyagi, Japan
| | - Hiroki Okano
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Tokyo, Japan
| | - Satoru Ikezawa
- Endowed Institute for Empowering Gifted Minds, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Kanami Tsuno
- School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
| | - Hiroshi Murayama
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Kiyohara K, Tabuchi T. Use of heated tobacco products in smoke-free locations in Japan: the JASTIS 2019 study. Tob Control 2020; 31:tobaccocontrol-2020-055951. [PMID: 33199542 DOI: 10.1136/tobaccocontrol-2020-055951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to examine the use of heated tobacco products (HTPs) in locations where cigarette smoking was not allowed, and to explore the factors associated with such use among Japanese HTP users. METHODS An internet-based self-reported questionnaire survey was conducted in 2019 as part of the Japan Society and New Tobacco Internet Survey. The study subjects were respondents who self-reported having used HTPs in the last year. The proportions of those who had ever used or frequently used HTPs in locations where tobacco smoking was not allowed in the last year were calculated. These locations included home, restaurants and workplaces. Furthermore, potential factors associated with HTP use in such smoke-free locations were examined using multivariable logistic regression analyses. RESULTS The proportion of HTP users who had ever used HTPs in smoke-free locations in the last year was 20.7% (148/716) at home, 11.8% (128/1081) in restaurants and 11.9% (113/950) in workplaces. The proportion of those who had frequently used HTPs in those locations was 9.5% (68/716) at home, 4.8% (52/1081) in restaurants and 8.0% (76/950) in workplaces. The statistically significant factors associated with HTP use varied by location. Generally, respondents who thought HTP use was not forbidden in places where tobacco smoking is forbidden were likely to use HTPs in such locations. CONCLUSION In Japan, a considerable number of people used HTPs in locations where tobacco smoking was not allowed. Policymakers should establish clear rules about use of HTPs in smoke-free environments.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Osaka, Japan
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Gallus S, Borroni E, Liu X, Carrozzi L, Dalla Pietra G, Eslami Varzaneh S, Harari S, Inciso G, Martucci P, Papale M, Pistelli F, Polla B, Polo MF, Principe R, Pulerà N, Raschi S, Sarzani R, Serafini A, Odone A, van den Brandt P, Lugo A. Electronic cigarette use among Italian smokers: patterns, settings, and adverse events. TUMORI JOURNAL 2020; 106:300891620915784. [PMID: 32338200 DOI: 10.1177/0300891620915784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Information is scanty on the patterns and settings of electronic cigarette use and on its possible adverse events. To fill the knowledge gap on these issues, we conducted a survey among ever-smokers attending smoking cessation services (SCS) in Italy. METHODS In 2016-2018, we enrolled 395 ever-smokers aged ⩾18 years who were current or former electronic cigarette users in 12 SCS from northern, central, and southern Italy. RESULTS In all, 12.4% of ever smokers were regular, 9.4% occasional, and 78.2% past users of electronic cigarettes. Of all users, 93.8% consumed electronic cigarettes with nicotine, 95.9% used refillable devices, and 76.6% purchased electronic cigarette devices or liquids in vape shops. The mean duration of use was 3.7 months and the mean number of puffs per day was 86. Among users, 71.5% used electronic cigarettes in at least 1 smoke-free indoor environment, 53.7% in workplaces, 49.5% in restaurants and bars, 33.5% in train/metro stations or airports, and 18.4% in public transports. The use of electronic cigarettes in smoke-free environments significantly decreased with age and increased with duration of use and nicotine dependence. In our sample, 47.1% reported at least 1 adverse event attributable to electronic cigarette use: 19.5% dry cough, 12.0% dry mouth, 7.6% throat or mouth irritation, and 6.8% sore throat. CONCLUSION In Italy, most conventional cigarette smokers use electronic cigarettes where smoking conventional cigarettes is prohibited. About half of users reported 1 or more symptoms attributable to electronic cigarettes, despite the relatively short duration of use.
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Affiliation(s)
- Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Elisa Borroni
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Xiaoqiu Liu
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | | | | | - Sergio Harari
- Department of Medical Sciences and Division of Pneumology, San Giuseppe Hospital, IRCCS MultiMedica, Milan, Italy
| | - Giovanni Inciso
- Unit of Pneumology, ASL Na 3 (Sanitary District 59), Meta di Sorrento, NA, Italy
| | - Paola Martucci
- Unit of Interventional Pneumology, Azienda Ospedaliera di Rilievo Nazionale "Antonio Cardarelli", Naples, Italy
| | - Maria Papale
- Department of Respiratory Physiopathology, Regina Elena Institute IRCCS, Rome, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Biagio Polla
- Department of Respiratory System Diseases, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Maria Francesca Polo
- Department of Pneumology, Azienda Ospedaliero Universitaria di Sassari, Sassari, Italy
| | | | - Nolita Pulerà
- Department of Pneumology, P.O. di Livorno-AUSL Toscana Nord Ovest, Livorno, Italy
| | - Stefania Raschi
- Department of Pneumology, ASST Vimercate, Vimercate, MB, Italy
| | | | | | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Piet van den Brandt
- Department of Epidemiology, CAPHRI-School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Alessandra Lugo
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Siripongvutikorn Y, Tabuchi T, Okawa S. Workplace smoke-free policies that allow heated tobacco products and electronic cigarettes use are associated with use of both these products and conventional tobacco smoking: the 2018 JASTIS study. Tob Control 2020; 30:147-154. [PMID: 32188769 DOI: 10.1136/tobaccocontrol-2019-055465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) are rapidly gaining popularity, especially in Japan. However, at the time of the survey (2018), there was no national legislation banning HTPs or e-cigarette use in the workplace. The objective is to examine the current situation for workplace smoke-free policies which ban the use of HTPs/e-cigarettes and the associations of such rules with the use of HTP and e-cigarette as well as conventional cigarette smoking. METHODS An internet-based self-reported questionnaire survey was conducted in 2018 as a part of the Japan Society and New Tobacco Internet Survey study. 5646 eligible employees aged 15-72 years were analysed. Proportions and adjusted rate ratios for HTP and e-cigarette use were calculated according to covariates, using Poisson regression models. Those who reported HTP or e-cigarette use within 30 days were defined as current user of the products. RESULTS In workplaces which prohibited smoking indoors but permitted the use of HTPs/e-cigarettes, the rate ratios of HTP use was 2.19 (95% CI 1.57 to 3.06), e-cigarette use was 3.86 (95% CI 1.97 to 7.57) and combustible cigarette use was 1.67 (95% CI 1.19 to 2.34) when using workplaces which also prohibited HTPs/e-cigarettes as a reference category. CONCLUSIONS Workplaces that allow HTP/e-cigarette use indoors were associated with higher rate for HTP and e-cigarette users, and for combustible cigarette smokers. National legislation banning tobacco should be enforced and also cover HTPs and e-cigarettes in order to avoid renormalisation of smoking and nicotine addiction.
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Affiliation(s)
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
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Inclusion of electronic nicotine delivery systems in indoor smoke-free air policies and associated vaping behavior. Addict Behav 2019; 98:106061. [PMID: 31377449 DOI: 10.1016/j.addbeh.2019.106061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/08/2019] [Accepted: 07/24/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Despite an ongoing debate over regulations of use of electronic nicotine delivery systems (ENDS) in public places, fourteen U.S. states or territories banned use of ENDS in indoor areas such as workplaces, restaurants, or bars (aerosol-free policies), as of March 31 ,2018. However, there is a paucity of studies on state-level aerosol-free policies. This study aimed to investigate the relationship between statewide aerosol-free policies and U.S. adults' ENDS use. METHODS We analyzed data from the 2016 Behavioral Risk Factor Surveillance System, a nationally representative sample of U.S. adults (N = 240,849, ages 18-59 years), using multilevel logistic regressions, taking into account clustering of individuals within a state. We conducted stratified analyses by age groups to examine if the association between aerosol-free policy and ENDS use would be different between different age groups of adults. RESULTS Adults living in the states with an aerosol-free policy were less likely to use ENDS compared with those living in the states without an aerosol-free policy, controlling for individual- and state-level covariates (adjusted odds ratio = 0.79, 95% confidence interval = 0.64, 0.97). Stratified analyses showed that the association varied by age group; the statewide aerosol-free policies was associated with lower odds of ENDS use only in adults aged 25-59 but not young adults (aged 18-24). CONCLUSIONS The results supported enforcement of prohibiting ENDS as well as traditional tobacco product indoor areas as a means of ENDS use prevention. Our findings also confirmed that young adults should be a priority target population for ENDS use prevention policies and programming efforts.
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Tigova O, Amalia B, Castellano Y, Fu M, Nogueira SO, Kyriakos CN, Mons U, Trofor AC, Zatoński WA, Przewoźniak K, Demjén T, Tountas Y, Quah ACK, Fong GT, Fernández E, Vardavas CI. Secondhand exposure to e-cigarette aerosols among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis 2019; 16:A11. [PMID: 31516465 PMCID: PMC6661852 DOI: 10.18332/tid/99117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/11/2018] [Accepted: 10/21/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Electronic cigarette (e-cigarette) use has grown significantly in some European Union (EU) Member States (MS). A better understanding of the exposure to secondhand e-cigarette aerosols (SHA) is necessary to develop and implement comprehensive regulations on e-cigarette use in public places. This study aims to assess the observation of e-cigarette use in public places, the self-reported exposure to SHA, and the level of users' comfort using e-cigarettes in the presence of others. METHODS This is a cross-sectional study of the Wave 1 International Tobacco Control 6 European Countries Survey recruiting adult smokers (n=6011) across six EU MS: Germany, Greece, Hungary, Poland, Romania, and Spain, within the EURESTPLUS Project. A descriptive analysis was conducted to estimate the prevalence (%) of observed e-cigarette use in different places, frequency of self-reported exposure to SHA, and level of comfort using e-cigarettes in the presence of others. RESULTS In all, 31.0% of smokers observed others using e-cigarette in public places, 19.7% in indoor places where smoking is banned, and 14.5% indoors at work. Almost 37% of smokers reported to be ever exposed to SHA, ranging from 17.7% in Spain to 63.3% in Greece. The higher prevalence of observed e-cigarette use and passive exposure to SHA was reported by smokers of younger age, of higher educational level and those being current or former e-cigarette users. Part (8.8%) of the smokers who were also e-cigarette users reported feeling uncomfortable using e-cigarettes in the presence of others. CONCLUSIONS A third of smokers from six EU MS reported being exposed to SHA. Prevalence differences were observed among the countries. In the context of scarce evidence on long-term health effects of exposure to SHA, precautionary regulations protecting bystanders from involuntary exposure should be developed.
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Affiliation(s)
- Olena Tigova
- Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Beladenta Amalia
- Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Yolanda Castellano
- Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Marcela Fu
- Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Sarah O. Nogueira
- Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Christina N. Kyriakos
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Witold A. Zatoński
- Health Promotion Foundation (HPF), Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Krzysztof Przewoźniak
- Health Promotion Foundation (HPF), Warsaw, Poland
- Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland
| | - Tibor Demjén
- Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland
| | - Yannis Tountas
- National and Kapodistrian University of Athens (UoA), Athens, Greece
| | - Anne C. K. Quah
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Geoffrey T. Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Esteve Fernández
- Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- University of Crete (UoC), Heraklion, Greece
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McKelvey K, Popova L, Kim M, Chaffee BW, Vijayaraghavan M, Ling P, Halpern-Felsher B. Heated tobacco products likely appeal to adolescents and young adults. Tob Control 2018; 27:s41-s47. [PMID: 30352843 PMCID: PMC6252490 DOI: 10.1136/tobaccocontrol-2018-054596] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Beginning in the 1960s in the USA and globally since 1998, tobacco companies have beenaggressively promoting heated tobacco products (HTP). In 2016, Philip Morris International (PMI) applied to the US Food and Drug Administration (FDA) seeking authorisation to market their IQOS HTP system and flavoured 'HeatSticks' in the USA as a modified-risk tobacco product (MRTP). METHODS We systematically evaluated the publicly available data PMI submitted to FDA in its MRTP application to determine whether PMI's IQOS product meets the US Tobacco Control Act's standard for MRTP claims. We examined whether PMI provided sufficient data showing tobacco users will not initiate with IQOS, that youth will not misperceive the MRTP-related claims being made concerning IQOS, and how youth perceive health risks associated with IQOS. RESULTS PMI's own studies failed to provide evidence that youth, including non-users and former users, will not find IQOS appealing, will not initiate use of IQOS and will not perceive these products as risk-free. Further, PMI did not refer to independent studies conducted among adolescents which could influence their conclusions. Finally, their studies suffered from design and implementation flaws and cannot be relied on to support the proffered claims. CONCLUSION PMI's own data and available evidence from scientific studies conducted independent of the tobacco industry regarding how novel tobacco products are currently being marketed suggest that introduction of IQOS will result in adolescent and young adult non-users initiating tobacco use with IQOS and could also increase poly-use of IQOS along with other tobacco products.
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Affiliation(s)
- Karma McKelvey
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Minji Kim
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Benjamin W Chaffee
- Division of Oral Epidemiology and Dental Public Health, University of California, San Francisco, California, USA
| | - Maya Vijayaraghavan
- General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Pamela Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
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Tabuchi T, Shinozaki T, Kunugita N, Nakamura M, Tsuji I. Study Profile: The Japan "Society and New Tobacco" Internet Survey (JASTIS): A Longitudinal Internet Cohort Study of Heat-Not-Burn Tobacco Products, Electronic Cigarettes, and Conventional Tobacco Products in Japan. J Epidemiol 2018; 29:444-450. [PMID: 30318495 PMCID: PMC6776477 DOI: 10.2188/jea.je20180116] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Japan became the first country where heat-not-burn tobacco products were sold. Therefore, there was no information for actual status on the actual use status or the harms of heat-not-burn tobacco products. The objectives of the study profile are to generate data that can be freely available to external researchers, and to create collaborative research projects in the future. Methods The Japan “Society and New Tobacco” Internet Survey (JASTIS) is a longitudinal internet cohort study which investigates perception, attitude, and use of heat-not-burn tobacco, electronic cigarettes (e-cigarettes), and conventional tobacco products in Japan. The survey also includes demographic, health-related, and socioeconomic factors. Participants were randomly selected and invited from internet panelists. The baseline survey was closed when the target number of respondents who had answered the questionnaire was met. Results The study includes three cohorts (1–3) from the 2015 baseline survey and a cohort (4) from the 2017 baseline survey: cohorts 1 and 4 were recruited based on sex and age: men and women aged 15–69 years (n = 8,240 for cohort 1 and n = 5,897 for cohort 4); cohorts 2 and 3 were created using status-based recruiting: e-cigarette and/or heat-not-burn tobacco ever users (n = 2,188; cohort 2) and combustible cigarette smokers without e-cigarette/heat-not-burn tobacco experience (n = 724; cohort 3). The completion rates were 8.5% to 9.9%. All subjects were followed and assessed annually. Response rates for the follow-up survey were 65.5% in 2016, 55.3% in 2017, and 50.9% in 2018. Because Internet-based responders are not a representative sample of the general population of Japan, we conducted adjustment to account for “being an internet survey respondent” and reported tobacco product use in Japan. A recent JASTIS study reported that prevalence of IQOS current-use among Japanese adults had rapidly increased from 0.3% in 2015 to 3.6% in 2017. Conclusion The JASTIS study provides the first estimates for heat-not-burn tobacco use in the world and e-cigarette use in Japan. For information on collaboration, please contact the corresponding author.
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Affiliation(s)
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, the University of Tokyo
| | - Naoki Kunugita
- Department of Environmental Health, National Institute of Public Health.,Health Promotion Research Center, Institute of Community Medicine, Japan Association for Development of Community Medicine
| | - Masakazu Nakamura
- School of Health Sciences, University of Occupational and Environmental Health
| | - Ichiro Tsuji
- Division of Epidemiology, Department of Health Informatics & Public Health, Tohoku University School of Public Health, Graduate School of Medicine
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14
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Tabuchi T, Gallus S, Shinozaki T, Nakaya T, Kunugita N, Colwell B. Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol. Tob Control 2018; 27:e25-e33. [PMID: 29248896 DOI: 10.1136/tobaccocontrol-2017-053947%jtobaccocontrol] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/28/2017] [Accepted: 11/02/2017] [Indexed: 05/24/2023]
Abstract
OBJECTIVES A heat-not-burn (HNB) tobacco product, IQOS, was first launched in Japan and Italy as test markets and is currently in commerce in 30 countries. Using two data sources, we examined interest in HNB tobacco (IQOS, Ploom and glo), its prevalence, predictors of its use and symptoms from exposure to secondhand HNB tobacco aerosol in Japan, where HNB tobacco has been sold since 2014. METHODS Population interest in HNB tobacco was explored using Google search query data. Prevalence of HNB tobacco current use (ie, use in the previous 30 days) was calculated using a longitudinal internet survey of 8240 individuals (15-69 years old in 2015) followed up to 2017. Rates of perceived symptoms from exposure to exhaled aerosol of others' HNB tobacco were also calculated. RESULTS The largest internet search volume for IQOS occurred in April 2016 in the week after a popular national entertainment TV show introduced IQOS. For Ploom and glo, search volumes have remained limited since their launch. Prevalence of IQOS users increased from 0.3% in January-February 2015 to 0.6% in January-February 2016 and up to 3.6% in January-February 2017, while estimated rates of use of other HNB tobacco products remained low in 2017. Respondents who had seen the TV programme in 2016 were more likely to have used IQOS than those who had not seen it (10.3% vs 2.7%). Among never-smokers who had been exposed to secondhand HNB tobacco aerosol, nearly half reported at least one acute symptom, although these symptoms were not serious. CONCLUSIONS A popular TV programme triggered IQOS diffusion in Japan. Extrapolating from survey results to the general population, around 3.1 million people currently use IQOS in Japan. Tobacco control organisations and governments should closely monitor HNB tobacco and consider how to regulate it.
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Affiliation(s)
- Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Silvano Gallus
- Department of Epidemiology, Laboratory of Lifestyle Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomoki Nakaya
- Department of Geography, College of Letters, Ritsumeikan University, Kita-ku, Kyoto, Japan
| | - Naoki Kunugita
- Department of Environmental Health, National Institute of Public Health, Wako City, Saitama, Japan
| | - Brian Colwell
- School of Public Health, Texas A&M University, College Station, Texas, USA
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15
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Tabuchi T, Gallus S, Shinozaki T, Nakaya T, Kunugita N, Colwell B. Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol. Tob Control 2017; 27:e25-e33. [PMID: 29248896 PMCID: PMC6073918 DOI: 10.1136/tobaccocontrol-2017-053947] [Citation(s) in RCA: 171] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/28/2017] [Accepted: 11/02/2017] [Indexed: 11/26/2022]
Abstract
Objectives A heat-not-burn (HNB) tobacco product, IQOS, was first launched in Japan and Italy as test markets and is currently in commerce in 30 countries. Using two data sources, we examined interest in HNB tobacco (IQOS, Ploom and glo), its prevalence, predictors of its use and symptoms from exposure to secondhand HNB tobacco aerosol in Japan, where HNB tobacco has been sold since 2014. Methods Population interest in HNB tobacco was explored using Google search query data. Prevalence of HNB tobacco current use (ie, use in the previous 30 days) was calculated using a longitudinal internet survey of 8240 individuals (15–69 years old in 2015) followed up to 2017. Rates of perceived symptoms from exposure to exhaled aerosol of others’ HNB tobacco were also calculated. Results The largest internet search volume for IQOS occurred in April 2016 in the week after a popular national entertainment TV show introduced IQOS. For Ploom and glo, search volumes have remained limited since their launch. Prevalence of IQOS users increased from 0.3% in January–February 2015 to 0.6% in January–February 2016 and up to 3.6% in January–February 2017, while estimated rates of use of other HNB tobacco products remained low in 2017. Respondents who had seen the TV programme in 2016 were more likely to have used IQOS than those who had not seen it (10.3% vs 2.7%). Among never-smokers who had been exposed to secondhand HNB tobacco aerosol, nearly half reported at least one acute symptom, although these symptoms were not serious. Conclusions A popular TV programme triggered IQOS diffusion in Japan. Extrapolating from survey results to the general population, around 3.1 million people currently use IQOS in Japan. Tobacco control organisations and governments should closely monitor HNB tobacco and consider how to regulate it.
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Affiliation(s)
- Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Silvano Gallus
- Department of Epidemiology, Laboratory of Lifestyle Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - Tomohiro Shinozaki
- Department of Biostatistics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomoki Nakaya
- Department of Geography, College of Letters, Ritsumeikan University, Kita-ku, Kyoto, Japan
| | - Naoki Kunugita
- Department of Environmental Health, National Institute of Public Health, Wako City, Saitama, Japan
| | - Brian Colwell
- School of Public Health, Texas A&M University, College Station, Texas, USA
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