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Abstract
Objective This study updates a previous paper that examined trends in the sale of cigarettes and heated tobacco products (HTPs) in Japan between 2011 and part way through 2019. The current study includes complete unit sales data through 2023.
Methods Data on cigarette and HTP sales were obtained from public sources available from the websites and stockholder reports for the Tobacco Institute of Japan, Philip Morris International and Japan Tobacco. We used joinpoint regression using the parametric method to test for trends in both per capita and total sales for the three outcome variables assessed between 2011 and 2023: (1) cigarette sales, (2) HTP sales and (3) combined cigarette and HTP sales. Joinpoint regression identifies changes in trends and estimates the annual per cent change (APC) for each trend segment.
Results Between 2011 and 2023, per capita and total cigarette sales declined by 52.6% and 52.7%, respectively. From 2011 to 2015, per capita cigarette sales in Japan decreased −1.5% APC; from 2015 to 2018, the decline accelerated to −10.5% APC and continued to fall −7.3% APC between 2018 and 2023. Between 2016 and 2018, per capita HTP sales increased by 149.0% APC, and since 2018, they have increased by 8.1% APC.
Conclusion While many factors may account for the decreased sale of cigarettes in Japan over the past 12 years, the increased sale of HTPs appears to be a factor.
- Nicotine
- Prevention
- Public policy
- Economics
- Tobacco industry
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
This study updates a previous paper that examined covariation in trends in the sale of cigarettes and heated tobacco products (HTPs) in Japan between 2011 and part way through 2019.
WHAT THIS STUDY ADDS
This paper updates the prior analysis to include trends in the sale of cigarettes and HTPs from 2019 to 2023 and shows that between 2011 and 2023, per capita and total cigarette sales in Japan declined by over 50%. The decline in cigarette sales was minimal from 2011 to 2015 but increased markedly after 2015 following the introduction of HTPs.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Halving the cigarette market in Japan in just over a decade is a remarkable achievement and figuring out how to replicate this type of change elsewhere should be a priority for public health research. Clinical trials are needed to test if HTPs can help addicted cigarette smokers transition away from smoking.
Introduction
As the harms of cigarette smoking have become better understood and smoking control measures have been put in place in many countries, cigarette sales have started to drop, especially in high-income countries.1 Cigarette makers have started diversifying their product lines to include various non-combustible nicotine products such as heated tobacco products (HTPs), electronic cigarettes and oral tobacco products.2
In 2019, Japan was among the 10 countries with the largest number of tobacco smokers worldwide.3 Japan was a testing ground for HTPs when IQOS was first launched by Philip Morris International (PMI) in Nagoya, Japan, in 2014, with national expansion in 2016.4–12 After PMI introduced IQOS, other cigarette companies, including Japan Tobacco (JT), British American Tobacco (BAT) and Imperial Tobacco (IT), also introduced HTPs in Japan. PMIs IQOS, JT’s Ploom X, BAT’s glo and IT Pulze HTPs all work essentially the same way. Each of these products uses a heated tobacco stick inserted into a battery-powered heating device that, when sucked on, causes the temperature in a heating chamber around the tobacco stick to heat the tobacco. The resulting aerosol contains nicotine and flavourings but lower levels of toxins than those found in conventional cigarettes.13 14 One heated tobacco stick is roughly equivalent to a single cigarette. JT’s Ploom Tech product is a hybrid system that uses tobacco-infused capsules and liquid cartridges inserted into a heating device with roughly four heated tobacco sticks, equivalent to a single capsule.
In a previously published paper, we reported that the decline in cigarette sales in Japan was associated with an increase in heated tobacco stick or equivalent sales up to part of 2019.15 This paper updates the prior analysis to include trends in the sale of cigarettes and HTPs from 2019 to 2023.
Methods
Data on cigarette and HTP sales used for this study were obtained from various public data sources available from websites and shareholder reports from the Tobacco Institute of Japan, PMI and JT. Table 1 shows total sales of cigarettes (billions of units), heated tobacco sticks or their equivalents (in billions) and per capita sales of both expressed as products divided by the Japanese population ≥18 years of age each year.
Total and per capita (≥18 years) sales of cigarettes and heated tobacco products* in Japan from 2011 to 2023
We used joinpoint regression using the parametric method to test for trends in both per capita and total sales for the three outcome variables assessed between 2011 and 2023: (1) cigarette sales, (2) HTP sales and (3) combined cigarette and HTP sales. Joinpoint regression identifies changes in trends and estimates the annual per cent change (APC) for each trend segment.16–18 We report the identified trend segments and the corresponding APCs and 95% CIs for each tobacco product group.
Results
Table 1 shows that between 2011 and 2023, per capita and total cigarette sales declined by essentially identical amounts, 52.6% and 52.7%, respectively. Our analytical results for per capita sales and total sales were comparable, so we only report findings based on per capita sales. Online supplemental materials provide the same analyses based on total sales. Figure 1 displays the trends in the per capita cigarette and HTP sales measures from 2011 to 2023.
Supplemental material
Per capita cigarette and heated tobacco stick or equivalent sales in Japan, 2011–2023.
Table 2 and figure 2 summarise the joinpoint regression results for per capita cigarette sales, HTPs and combined cigarettes and HTPs. As shown in table 2, from 2011 to 2015, per capita cigarette sales in Japan decreased slightly at a −1.5% APC (95% CI −3.0% to 0.0%). From 2015 to 2018, the decline in per capita cigarette sales accelerated to −10.5% APC (95% CI −14.6% to −6.1%), and it continued to fall at a rate of −7.3% APC (95% CI −8.2% to −6.3%) between 2018 and 2023. Between 2016 and 2018, per capita HTP sales increased by 149.0% APC (95% CI 132.3% to 166.8%). Since 2018, it has increased at an 8.1% APC (95% CI 6.4% to 9.8%). Combined sales decreased from 2011 to 2023 at −2.6 APC (95% CI −2.9 to −2.3).
Joinpoint regressions testing for trends in per capita cigarette, heated tobacco stick or equivalent and combined cigarette and heated tobacco stick or equivalent sales in Japan 2011–2023
Joinpoint regression plots for per capita cigarette, heated tobacco stick or equivalent, and combined cigarette and heated tobacco stick or equivalent sales in Japan, 2011-2023.
Discussion
Between 2011 and 2023, per capita and total cigarette sales in Japan declined by 52.6% and 52.7%, respectively. During the same time period in the USA, per capita cigarette sales dropped by about 45%.19 In both the USA and Japan, the cigarette market is declining at least partially in response to a more diverse marketplace of nicotine and tobacco products. In Japan, HTPs are the primary legal competition for cigarettes, whereas in the USA, the decline in cigarette consumption is associated with the increased use of electronic cigarettes and oral tobacco products.4 20
The downward shift in cigarette sales in Japan after 2015 is remarkable since Japan has been slow in adopting tobacco control policies consistent with the WHO’s Framework Convention on Tobacco Control and its guidelines.21 This is especially true for tobacco advertising and sponsorship, in which the JT Association self-regulates its members. Thus, both cigarettes and HTPs are widely marketed with few restrictions. Also, while Japan prohibits the sale of nicotine-containing electronic cigarettes, there are likely illicit sales of e-cigarettes happening which, if prevalent, could be accounting for some of the decline in cigarette sales.22
In Japan, per capita cigarette sales declined sharply between 2016 and 2018, right after HTPs were introduced into the marketplace. From 2018 to 2023, per capita cigarette sales continued to decrease while HTP sales continued to increase, but both at a slower pace, corresponding to tax increases on both cigarettes and HTPs and the introduction of non-tax tobacco control measures such as smoke-free laws and larger text-only health warnings.23 24
Because this study relies on aggregate sales data, we cannot address the extent to which individual cigarette smokers are substituting HTPs, either partially or completely, for conventional cigarettes or their reasons for doing so. Recent studies of HTP users in Japan report that most HTP users also smoke cigarettes, which would reduce the potential harm reduction benefit of the growing sales and use of HTPs.7–11 Also, HTPs are used more often by younger age groups, whereas older adults are more likely to smoke cigarettes.7 12
Other factors may account for the fall in cigarette sales in Japan including the increase in tobacco prices although inexpensive by international standards.12 21 22 However, the introduction and competitive marketing of HTPs beginning in 2016 in Japan does correspond to declining cigarette sales which is also consistent with prevalence trends reflected in Japan’s National Health and Nutrition Surveys covering a similar period.12 15 Nicotine products are known substitutes for cigarettes and can aid smoking cessation, so there is a plausible causal mechanism.25 26 Developing a better understanding of the mechanisms involved in halving the cigarette market in Japan in just over a decade and working out how best to replicate such changes elsewhere should be a priority for public health research.
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
Ethics statements
Patient consent for publication
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
X @gfong570
Contributors Conceptualisation: KMC and DTS (lead). Data curation: KMC and DTS (lead). Formal analysis: KMC, AR and KEW (lead). Funding acquisition: KMC and GTF (lead). Methodology: KMC and DTS (lead). Writing–original draft preparation: KMC, AR and DTS (lead). Writing–review and editing: all authors (equal contribution). As the corresponding author, I – KMC – am responsible for the overall content (as guarantor) for the paper.
Funding US National Cancer Institute (P01 CA200512, P30 CA138313).
Competing interests KMC has been a paid expert witness in litigation against the cigarette industry. MLG received a research grant from Pfizer and served as a member of the scientific advisory board of Johnson & Johnson. GTF has served as an expert witness and consultant for governments defending their country’s tobacco control policies and regulations in litigation, and was and unpaid member of he Health Canada Vaping Products Scientific Advisory Group 2017-2020. All others have no conflicts of interest to declare.
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.