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Poland is not replicating the HTP experience in Japan: a cautionary note
  1. Alex C Liber1,
  2. Christopher Cadham2,
  3. Michael Cummings3,
  4. David T Levy1,
  5. Michael Pesko4
  1. 1 Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
  2. 2 Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  3. 3 Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4 Economics, Georgia State University Andrew Young School of Policy Studies, Atlanta, Georgia, USA
  1. Correspondence to Dr Alex C Liber, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA; alex.liber{at}

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In a 2019 article, Stoklosa et al found that the introduction of heated tobacco products (HTPs) to the Japanese market was strongly associated with a decline in cigarette sales.1 This paper and another by Cummings et al 2 provide suggestive evidence that the Japanese population replaced cigarettes sold with HTPs. Instead of delivering nicotine from tobacco leaves through combustion, HTPs heat tobacco to considerably lower temperatures and deliver nicotine to users via an aerosol containing fewer toxic substances than cigarettes and could reduce health risks for users.2 If this pattern of substitution in Japan reflects persistent individual behaviour changes, then health improvements could follow.

Philip Morris International has used this independently produced research to lobby governments to gain favourable terms of market access for their HTPs.3 However, it merits examining whether trends in Japan mirror changes elsewhere. In particular, we explore Poland, 1 of about 60 other countries where HTPs are sold, because it has some key differences with Japan: HTPs were introduced in Japan in 2015, and in Poland in 2017, e-cigarette sales are not allowed in Japan but are sold in Poland, and HTP excise taxes as a per cent of retail prices in 2020 were 43% in Japan and 12.4% in Poland.4 However, in 2019, both markets had similar shares of menthol cigarette sales and similar levels of male smoking.5 Further in both countries, in the 5 years …

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  • Contributors ACL conceived the study, obtained the data, performed the data analysis and wrote the first draft of the manuscript. CC, MP, DTL and MC guided the development of the analysis, the interpretation of the results and edited the final manuscript.

  • Funding The purchase of this data was made possible by a grant from the Norwegian Cancer Society.

  • Disclaimer The views expressed in this work are the authors and do not represent the views of the Norwegian Cancer Society, The Polish Ministry of Health or NielsenIQ. The authors’ analyses and calculations are based in part on data reported by NielsenIQ through its Retail Measurement Service for the Cigarettes, Tobacco, E-cigarettes, Heated Tobacco categories for the 12-month period ending April 2021, for the Total Poland market and Warsaw City, Central, West, East, North, South, South-East, South-West regions (cigarettes and tobacco categories only). Copyright 2021, Nielsen Consumer. The conclusions drawn from the NielsenIQ data are those of the authors and do not reflect the views of NielsenIQ. NielsenIQ is not responsible for and had no role and was not involved in analysing and preparing the results reported herein, including without limitation, any adjustments on pricing for inflation.

  • Competing interests MC has served on advisory committees for Pfizer to assist them in ways to promote access to smoking cessation treatments. He has also served as a paid expert witness in litigation filed against the tobacco industry. The other authors have no conflicts of interest to declare.

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