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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
  1. Yusuke Matsuyama1,
  2. Takahiro Tabuchi2
  1. 1Global Health Promotion, Tokyo Medical and Dental University, Bunkyo, Japan
  2. 2Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  1. Correspondence to Dr Yusuke Matsuyama, Global Health Promotion, Tokyo Medical and Dental University, Bunkyo 113-8510, Japan; matsuyama-thk{at}


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.

  • non-cigarette tobacco products
  • prevention
  • cessation

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  • Contributors Both authors conceptualised the study. Acquisition of data: TT. Analysis and interpretation of data: both authors. Drafting of the manuscript: YM. Critical revision of the manuscript for important intellectual content: TT. Both authors gave final approval and agree to be accountable for all aspects of the work.

  • Funding The work was supported by Health Labour Sciences Research Grants (20FA1005, 19FA0501, 19FA2001 and 19FA1011) and the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant (18H03062).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Research Ethics Committee of the Osaka International Cancer Institute (no. 1412175183) and the National Institute of Public Health (NIPH-IBRA#12112).

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

  • Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (YM) upon reasonable request.