Awareness and use of electronic cigarettes and heat-not-burn tobacco products in Japan

Background and aims: In addition to some electronic cigarettes (e-cigarettes), new heat-not-burn tobacco products Ploom and iQOS have recently begun to be sold by tobacco companies. These products are regulated differently in Japan, depending on whether the contents are liquid or tobacco leaf. Our objective was to estimate percentages of awareness and use of e-cigarettes and heat-not-burn tobacco products among the Japanese population, including minors.

Design and setting: An internet survey (randomly sampled research agency panellists) with a propensity score adjustment for "being a respondent in an internet survey" using a nationally representative sample in Japan.

Participants: A total of 8240 respondents aged 15-69 years in 2015 (4084 men and 4156 women).

Measurements: Adjusted percentages of awareness and use of e-cigarettes (nicotine or non-nicotine e-cigarettes) and heat-not-burn products among total participants; product types and percentages ever used among e-cigarettes ever users.

Findings: Of respondents in Japan, 48% [95% confidence interval (CI) = 47-49] were aware of e-cigarettes and heat-not-burn tobacco products, 6.6% (95% CI = 6.1-7.1) had ever used, 1.3% (95% CI = 1.0-1.5) had used in the last 30 days and 1.3% (95% CI = 1.1-1.6) had experience of > 50 sessions. Seventy-two per cent (95% CI = 69-76) of ever users used non-nicotine e-cigarettes, while 33% (95% CI = 30-37) of them used nicotine e-cigarettes, which has the majority share world-wide; 7.8% (95% CI = 5.5-10.0) and 8.4% (95% CI = 6.1-10.7) of them used the new devices, Ploom and iQOS, respectively, with a relatively higher percentage among the younger population.

Conclusions: Approximately half the respondents in a Japanese internet survey were aware of e-cigarettes and heat-not-burn tobacco products, 6.6% had ever used. More than 70% of ever users used non-nicotine e-cigarettes, the sale of which is not legally prohibited, even to minors, in Japan, and 33% of them used nicotine e-cigarettes; 3.5% of never smoking men and 1.3% of never smoking women had ever used e-cigarettes. Corresponding figures for use in the last 30 days were 0.6% and 0.3%, predominantly non-nicotine e-cigarettes.