Japan’s strategy proves effective in cutting down smoking rate


Countries around the world may look at Japan’s success in significantly cutting down the smoking problem with the introduction of heated tobacco product—a smoke-free alternative that carries far less harm than traditional cigarettes.

“Currently approved smoking cessation strategies such as ‘quitting cold turkey’, prescription medicines and nicotine replacement therapy do not work for many smokers. For such smokers as well as those who do not want to quit, heated tobacco products provide a less harmful alternative,” said Dr. Peter Harper, a consultant medical oncologist at Guy’s and St. Thomas Hospital in London and chairman of the Toulouse Cancer Centre in France.

An independent study found that heated tobacco has accelerated the decline in cigarette sales in Japan. Researchers at the Medical University of South Carolina and at the University of Ottawa said the acceleration in the decline in cigarette sales in Japan since 2016 does, in fact, correspond to the introduction and growth of sales of heated tobacco products in the country.

This provides countries such as the Philippines an opportunity to help millions of smokers who would otherwise continue to smoke if not given an effective alternative.

“The dramatic drop in smoking prevalence in Japan happened because of the availability of heated tobacco products which enabled many smokers, who would have otherwise continued to smoke cigarettes, to switch to less harmful smoke-free alternatives,” said Dr. David Khayat, a professor of Oncology at Pierre et Marie Curie University and head of Medical Oncology at La Pitié-Salpétrière Hospital, both in Paris, and adjunct professor at the MD Anderson Cancer Center in Houston, Texas.

Data show that after the introduction of heated tobacco in Japan in late 2014, combustible tobacco sales registered 9.5 percent in average annual decline from 2015 to 2018.  In the Philippines, 1 in 4 adults are smokers and the annual smoking quit rate is a measly 4 percent.

In the Philippines, PMI’s local affiliate PMFTC Inc. introduced IQOS in 2020 and the more affordable BONDS by IQOS last year. These devices are specifically used with specially designed tobacco sticks called HEETS and BLENDS, respectively. Both products do not burn tobacco. They generate smoke-free aerosol instead of smoke.

The Japanese National Health and Nutrition Survey (NHNS) noted a profound decline in adult cigarette smoking prevalence following the introduction of heated tobacco products. While 20 percent of adults reported smoking every day or some days in 2014 (prior to the introduction of heated tobacco products), smoking prevalence dropped to 13 percent in 2019. The survey also showed that an overwhelming majority of heated tobacco users, 76 percent in 2019, did not report any cigarette smoking.

Heated tobacco products heat tobacco just enough to release a nicotine-containing aerosol without burning the tobacco. Because tobacco is heated and not burned, there is no smoke, and the levels of harmful and potentially harmful chemicals in the generated aerosols can be significantly reduced compared to cigarette smoke.

“People smoke for nicotine but die from the burning of tobacco at over 350°C. The combustion of tobacco generates smoke and ash containing a toxic mix of chemicals that causes serious health effects, including fatal lung diseases and cancer,” said Dr. Harper.

“Nicotine does not cause cancer. Doctors even prescribe nicotine replacement therapy to help smokers quit. Exposure to the carcinogens present in the smoke of combustible cigarette is what causes cancer. There is a dose-response relationship – the greater the exposure to a carcinogen, the higher the risk to develop cancer,” said Dr. Khayat.

IQOS, the heated tobacco brand of Philip Morris International (PMI), was introduced in Nagoya, Japan in late 2014 as a city-pilot and launched nationwide in staggered phases through 2016. Data show that Following the introduction of IQOS, cigarette sales began to substantially decline in each of the Japanese regions from 2015 to 2016. Before this nationwide launch, total tobacco sales in Japan declined at a rate of 1.8 percent on average between 2011 and 2015.

Japan has the highest prevalence of heated tobacco use in the world and is the country where heated tobacco products have captured the highest share of the tobacco market. PMI research revealed that heated tobacco uptake in Japan coincided with an accelerated decline in the sales of the predominant combustible tobacco categories, cigarettes and cigarillos in the country. Across all brands, heated tobacco products reached almost one third of the total tobacco market in Japan by 2021.

The introduction of IQOS was the most likely explanation for the remarkably progressive decline in cigarette sales in Japan, according to researchers working for the American Cancer Society who published their study in the British Medical Journal’s Tobacco Control. The independent study looked at 2014-2018 cigarette sales data from 11 of Japan’s 12 regions, representing 99 percent of the country’s population, and 72 percent of all cigarette sales.

Aside from the launch of heated tobacco, the researchers investigated other potential causes for the decline, such as pricing, stricter regulations, the availability of competing heated tobacco products, or even just chance. They determined that those factors were unlikely to be the main causes of the decline in cigarette sales.

Furthermore, the downward trend of combined tobacco sales continued even after the launch of heated tobacco. This can be interpreted to mean that it did not lead to an increase in overall tobacco consumption, and that many smokers in Japan, who would have otherwise continued to smoke cigarettes, have switched to heated tobacco.

Meanwhile, a peer-reviewed study that looked at real-world data from the Japan Medical Data Center (JMDC) insurance claims database found a statistically significant reduction in hospitalization rates for chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) in Japan after the introduction of heated tobacco products.

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