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Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan
  1. Satomi Odani1,
  2. Kanami Tsuno2,
  3. Israel T Agaku3,
  4. Takahiro Tabuchi1
  1. 1Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  2. 2School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
  3. 3Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
  1. Correspondence to Satomi Odani, Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan; satomi.ichikawa1029{at}


Background Heated tobacco products (HTPs) are often marketed as a safer alternative to help cigarette smokers quit. We investigated the link between HTP use and smoking cessation and relapse.

Methods 7044 adults (≥20 years old) with at least two observations over three waves (2019–2021) of a longitudinal, nationwide, internet-based survey were classified into current (past 30-day), former and never cigarette smokers. ≥1 month and ≥6 months smoking cessation and smoking relapse at 1-year follow-up were assessed in relation to current HTP use at baseline. Generalised estimating equation models were weighted to account for population differences between HTP users and non-users. Adjusted prevalence ratios (APRs) were computed within population subgroups.

Results At baseline, 17.2%, 9.1% and 6.1% of the respondents were current cigarette smokers, HTP users and dual users, respectively. Among current established smokers (having smoked regularly, n=1910), HTP use was significantly associated with a decreased likelihood of ≥1 month cessation within those who reported having used evidence-based cessation measures (APR=0.61), smoking 20+ cigarettes per day (APR=0.62), high school education or less (APR=0.73) and fair/poor health (APR=0.59). Negative associations were also seen for ≥6 months cessation among those aged 20–29 years (APR=0.56) and full-time workers (APR=0.56). Among former smokers (n=2906), HTP use was associated with smoking relapse within those who last smoked >1 year ago (APR=1.54), among women (APR=1.61), those aged 20–29 years (APR=2.09), those reporting high school education or less (APR=2.36), those who were unemployed/retired (AOR=3.31) and never/non-current alcohol users (APR=2.10).

Conclusion HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.

  • Cessation
  • Denormalization
  • Non-cigarette tobacco products
  • Surveillance and monitoring

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the author (TT) upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the author (TT) upon reasonable request.

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  • Contributors SO and KT equally contributed to designing the study. SO conducted data analysis and drafted the manuscript. TT designed the survey, monitored data collection, and conceptualised the study. TT is responsible for the overall content as guarantor. All authors contributed to data interpretation and critically reviewed and revised the manuscript.

  • Funding This study was supported by the Japan Society for the Promotion of Science KAKENHI Grant (#21H04856) and Health Labour Sciences Research Grant (#19FA1005, 19FA1012, 19FA1011 and 20FA1005).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.