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Since 2014, heated tobacco products have become increasingly popular in a number of countries, including Japan. As other researchers showed using sales volume data, the introduction of heated tobacco products in Japan coincided with an accelerated decline in cigarette sales. We examined the evolution of smoking prevalence in Japan before and after the introduction of heated tobacco products using data from the National Health and Nutrition Survey (from 2010 to 2019), as well as more recent (2016 to 2021) data from repeated, nationally representative, cross-sectional population surveys conducted by Philip Morris International. The results from both surveys show similar temporal trends: overall tobacco use moderately declined following the introduction of heated tobacco products, with the share of tobacco users who smoke declining at an accelerated pace while the prevalence of heated tobacco product use simultaneously increased. These trends indicate that heated tobacco products are successfully replacing combusted tobacco products in Japan and have likely contributed to a decline in the prevalence of cigarette smoking. While the prevalence of cigarette smoking had plateaued at 19-20% before 2015, the introduction and uptake of heated tobacco products coincided with a decrease of smoking prevalence to 13%.

AUTHOR: Ondrej Koumal

AFFILIATION: Philip Morris International

Background: The prevalence of tobacco use is a dynamic phenomenon, influenced by a number of socio-economic and health factors. In each population, it is important to know the scale of the phenomenon, as well as to understand its characteristics. The aim of the study was to determine the frequency of smoking traditional cigarettes and using e-cigarettes and heated tobacco (HnB, heat-not-burn) in the adult population of Poland and to determine whether new products (e-cigarettes, HnB) are used together with traditional cigarettes.

Material and Methods: A survey was conducted on a representative sample of 5000 Polish residents aged over 18. The survey was carried out from March to May 2022 using the Computer-Assisted Telephone Interviewing (CATI) method.

Results: Out of the total number of respondents (n=5000), 21.1% of the respondents currently smoke traditional cigarettes (25.5% among men and 17% among women; p<0.001); 3.3% of respondents use e-cigarettes, and 3.5% of respondents use heated tobacco. There were no gender differences in using e-cigarettes or HnB products. Out of the total number of respondents, 21.4% (95% CI: 20.3-22.6) currently use only one of the three analyzed products (traditional cigarettes, e-cigarettes, and heated tobacco). Two products were used by 2.6% (95% CI: 2.2-3.0) and three by 0.4% (95% CI: 0.3-0.6) of the study participants. Among people who use e-cigarettes every day, 5.4% (95% CI: 2.0-10.8) are the ones who have never smoked conventional cigarettes, and 65.7% (95% CI: 55.5-74.2) are former smokers. Among occasional e-cigarette users it was 3.1% (95% CI: 0.6-9.2) and 32.2%, respectively. Of those who use heated tobacco daily, 2.1% (95% CI: 0.5-6.9) are people who have never smoked conventional cigarettes and 64.2% (95% CI: 54.7-74.1) are former smokers. Among occasional users of heated tobacco, the percentages were 6.4% (95% CI: 2.4-12.8) and 38.8% (95% CI: 29.0-49.8), respectively. Nicotine containing product that was declared as a first ever tried in life, regardless of age group, was traditional cigarette (93.8%), then e-cigarette (5.6%) and heated tobacco product (0.6%). In the group of 18-24 years old, e-cigarettes were declared by 22% of respondents which was more frequent than in other age groups. Conclusions: In Poland, smoking traditional cigarettes is still common (one in five adults smoke every day). Currently, the percentage of users of e-cigarettes and heated tobacco is at a similar level (just over 3% of the adult population). In the case of e-cigarettes and HnB, two-thirds of everyday users are people who previously smoked traditional cigarettes but currently do not smoke. The nicotine containing product declared as the first one ever used is traditional cigarette.

AUTHORS: Piotr Samel-Kowalik, Filip Raciborski, Bolesław Samoliński

AFFILIATION: Department of Prevention of Environmental Hazards, Allergology and Immunology, Medical University of Warsaw, Poland

Background: Risk perception (RP) is a key factor influencing current adult smokers’ decision to switch to smoke-free tobacco and nicotine products (TNP). This study assesses changes in health RP of a novel smoke-free heated tobacco product (IQOS^TM) relative to cigarettes, among current IQOS^TM users.

Material and Methods:  The analyses included data from four repeated cross-sectional surveys conducted in Japan (n=6881, years 2016-17, 2017-18, 2018-19, and 2020-21) among current adult IQOS^TM users recruited from PMI’s IQOS Owners Database. The health RPs of cigarettes and IQOS^TM were assessed using the Health Risk scale of the ABOUT™ - Perceived Risk instrument. The score ranged from zero, indicating no perceived risk, to 100, indicating very high perceived risk. Relative RP of IQOS^TM to cigarettes (RP_{Cigarettes-IQOS}) was computed as the difference in absolute RP scores of cigarettes minus IQOS^TM.

Results: In Japan, RP of cigarettes has remained stable over the years while RP of IQOS^TM has increased over time from 44.0 (95% CI: 43.1-45.0) to 49.4 (95% CI: 48.5-50.3). The change was reflected in relative RP of IQOS^TM’s gradual decline from 19.5 (95% CI: 18.5-20.5) to 12.7 (95% CI: 11.9-13.4). IQOS^TM’s relative RP was higher among exclusive IQOS users compared to dual users, and increased with the number of HEETS^TM used and length of IQOS^TM ownership.

Conclusions: IQOS^TM’s relative RP decreased over time, driven by an increase in IQOS^TM’s RP, in agreement with epidemiological studies indicating a temporal reduction in smoke-free TNPs’ relative RP. Regular surveillance of the RP of novel smoke-free TNPs is warranted to inform TNP risk communications and ensure that current adult smokers who would otherwise continue to smoke receive adequate communications on novel TNPs’ relative risks.

AUTHORS: Suzana Almoosawi¹, Karina Fischer¹, Pitt Bargfried², Gerd Kallischnigg², Bertram Zwisele², Medy Ehtesham¹, Steve Roulet¹, Pierpaolo Magnani¹

AFFILIATIONS: ¹Philip Morris International || ²Argus GMBH

Background: Smoking is endemic among people with mental health disorders, with prevalence remaining high despite the significant decline in the general population in recent years. The impact of smoking-attributable morbidity on life expectancy is significant as people with severe mental disorders have a 15–20-year reduction in life expectancy compared to the general population.

Material and Methods: A cross-sectional study was conducted among 1015 people with mental health disorders through a personal interview. Patients were recruited from the outpatient department, community care accommodations and inpatient facilities of the Psychiatric Hospital of Attica. The questionnaire was designed to examine knowledge, perceptions and attitudes of these patients toward smoking. Statistical analysis was performed using SPSS 24.0.

Results: The prevalence of current smoking was 68.2% (n=692), while 12.2% (n=124) were former smokers. Most current smokers (85.3%) smoked their first cigarette within 30 minutes of waking up, and 60.1% found it difficult not to smoke in non-smoking areas. Former smokers’ main motive to quit smoking was for health reasons (84.7%), and almost all of them (97.6%) had quit without using any smoking cessation aid. Only 11.4% of participants believe that health professionals inform smokers about smoking cessation programs and harm reduction strategies. Moreover, only 53% of participants believe that health professionals inform patients about the harmful health effects of tobacco. Non-smoking patients had fewer psychiatric readmissions than smoking patients. Males, divorced patients, outpatients and patients with past history of hospitalization in a psychiatric clinic were more likely to be current smokers. Patients living in community care accommodations were less likely to be current smokers.

Conclusions: High prevalence of current smoking and smoking dependence is observed among patients with mental health disorders. Healthcare professionals need to step up their efforts in discussing with patients about their smoking habit and in providing guidance about relevant cessation programs and harm reduction strategies.

AUTHORS: Georgia Papadosifaki^1,2, Anastasia Barbouni¹, Areti Lagiou¹, Konstantinos Farsalinos¹

AFFILIATIONS: ¹Department of Public and Community Health, University of West Attica, Greece || ²Psychiatric Hospital of Attica, Greece

Background: Perceived reduced formation of harmful chemicals (RF) or reduced risk of harm (RH) of smoke-free tobacco products (TP) relative to combustible TPs may influence their acceptance and use patterns among current adult cigarette smokers and therefore impact public health. We analyzed whether and how perceived RF and/or RH of Philip Morris International (PMI)’s heated TP (HTP) IQOS^TM impacted “exclusive” (100%) IQOS use in Japan, Italy, Germany, and Russia.

Material and Methods: Between 2016 and 2020, adult participants from longitudinal IQOS Owner consumer cohorts in Japan (N=6257), Italy (N=8137), Germany (N=8474), and Russia (N=7231) repeatedly indicated the reasons for using IQOS, including reasons referring to RF and RH, during their 48 weeks of follow-up. Logistic regression was used to analyze the relationships between RF and/or RH indications for using IQOS and exclusive IQOS use.

Results: At week 48, exclusive IQOS use in Japan (odds ratio [OR]: 1.89), Italy (OR: 3.35), Germany (OR: 3.48), and Russia (OR: 3.05) was more likely for the highest versus lowest category of number of RF and/or RH indications. Similar results were observed for overall HTP use in Japan, where other HTPs were also available. In Japan, where RF and RH could be indicated separately as reasons for using IQOS, indicating RH (OR: 2.92) versus RF (OR: 1.81) resulted in a greater likelihood of exclusive IQOS use within the highest category of RF or RH indications.

Conclusions: The perceived RF and/or RH of IQOS, especially when indicated with certainty, have a significant impact on users switching from cigarette smoking to exclusive IQOS use. This also seems to be true for the overall HTP category. Moreover, perceived RH of IQOS was a stronger driver for exclusive IQOS use than perceived RF.

AUTHORS: Karina Fischer¹, Steve Roulet¹, Andreea Surducan², Mario Colombo², Pierpaolo Magnani¹

AFFILIATIONS: ¹PMI R&D, Philip Morris Products S.A., Neuchâtel, Switzerland || ²Smartech s.r.l., Milano, Italy

Funding: Philip Morris International is the sole source of funding and sponsor of this research.

Declaration of Interest: K.F., S.R., and P.M. are employees of Philip Morris International. A.S. and M.C. are employees of Smartech s.r.l., a scientific market research consulting company commissioned by Philip Morris International.