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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
  1. Yanakawee Siripongvutikorn1,
  2. Takahiro Tabuchi2,
  3. Sumiyo Okawa2
  1. 1 Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Japan
  2. 2 Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  1. Correspondence to Dr Takahiro Tabuchi, Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan; tabuti-ta{at}


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.

  • electronic nicotine delivery devices
  • non-cigarette tobacco products
  • public policy

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  • YS and TT contributed equally.

  • Contributors TT had full access to all of the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: YS, TT. Acquisition of data: TT. Analysis and interpretation of data: all authors. Drafting of the manuscript: YS. Critical revision of the manuscript for important intellectual content: YS, TT, SO. Statistical analysis: YS, TT. Study supervision: TT.

  • Funding This work was supported by Health Labour Sciences Research Grants (H26-junkankitou-ippan- 023 and H28-junkankitou-ippan-002), and Japan Society for the Promotion of Science (JSPS) KAKENHI Grants (15K19256; 18H03062).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • 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 availability statement Data are available on reasonable request. The JASTIS data can be accessed via the corresponding author, TT, on reasonable request.