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Heat-not-burn tobacco product use in Japan: its prevalence, predictors and perceived symptoms from exposure to secondhand heat-not-burn tobacco aerosol
  1. Takahiro Tabuchi1,
  2. Silvano Gallus2,
  3. Tomohiro Shinozaki3,
  4. Tomoki Nakaya4,
  5. Naoki Kunugita5,
  6. Brian Colwell6
  1. 1 Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  2. 2 Department of Epidemiology, Laboratory of Lifestyle Epidemiology, Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milan, Italy
  3. 3 Department of Biostatistics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
  4. 4 Department of Geography, College of Letters, Ritsumeikan University, Kita-ku, Kyoto, Japan
  5. 5 Department of Environmental Health, National Institute of Public Health, Wako City, Saitama, Japan
  6. 6 School of Public Health, Texas A&M University, College Station, Texas, USA
  1. Correspondence to Dr Takahiro Tabuchi, Cancer Control Center, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan; tabuti-ta{at}


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.

  • electronic nicotine delivery devices
  • non-cigarette tobacco products
  • surveillance and monitoring

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  • Contributors TT had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: all authors; acquisition of data: TT and NK; analysis and interpretation of data: all authors; drafting of the manuscript: TT, SG and BC; critical revision of the manuscript for important intellectual content: all authors; statistical analysis: TT and TS; and study supervision: SG, TN, NK and BC.

  • Funding This work was supported by Health Labour Sciences Research Grants (H26-junkankitou-ippan-023, H28-junkankitou-ippan-002, H28-junkankitou-ippan-008 and H29-tokubetsu-shitei-006) and Japan Society for the Promotion of Science (JSPS) KAKENHI Grants (15H02964 and 15K19256). The work of SG was partially funded by the European Union’s Horizon 2020 Research and Innovation Programme (The TackSHS Project; grant agreement: 681040).

  • Disclaimer The funding sources had no role in the design and conduct of the study; in the analysis and interpretation of the data; or in the preparation, review, or approval of the manuscript.

  • Competing interests None declared.

  • Ethics approval The study was reviewed and approved by the Research Ethics Committee of the Osaka International Cancer Institute (no. 1412175183).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Our rule for data sharing of raw data is under consideration.

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