Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

Abstract

In Japan, the tobacco industry promotes heated tobacco products (HTPs) as a reduced-risk tobacco product. This study examines: (1) smokers' harm perceptions of HTPs relative to combustible cigarettes; (2) differences in relative harm perceptions between exclusive smokers and smokers who use HTPs (concurrent users) and between concurrent users based on frequency of product use; and (3) if smokers who were exposed to HTP advertising hold beliefs that are consistent with marketing messages of lower harmfulness. This cross-sectional study included 2614 adult exclusive cigarette smokers and 986 concurrent users who reported their perceptions of harmfulness of HTPs compared to cigarettes, as well as their exposure to HTP advertising in the last six months. Among all smokers, 47.5% perceive that HTPs are less harmful than cigarettes, 24.6% perceive HTPs to be equally as harmful, 1.8% perceive HTPs as more harmful, and 26.1% did not know. Concurrent users are more likely than exclusive smokers to believe that HTPs are less harmful (62.1% versus 43.8%, p < 0.0001) and less likely to report that they did not know (14.3% versus 29.4%, p < 0.0001). Frequent HTP users are more likely than infrequent users to believe that HTPs are less harmful (71.7% versus 57.1%, p ≤ 0.001). Believing that HTPs are less harmful than cigarettes was associated with noticing HTP advertising on TV (p = 0.0005), in newspapers/magazines (p = 0.0001), on posters/billboards (p < 0.0001), in stores where tobacco (p < 0.0001) or where HTPs (p < 0.0001) are sold, on social media (p < 0.0001), or in bars/pubs (p = 0.04). HTP users were significantly more likely than non-HTP users to believe that HTPs are less harmful than cigarettes, with this belief being more prominent among frequent users. Smokers who have been exposed to HTP advertising were more likely to perceive HTPs as less harmful than cigarettes.

Keywords: combustible cigarettes; heat-not-burn; heated tobacco products; modified risk tobacco products; perceptions of harm; risk.

Figure 1

Relative perceptions of harmfulness of HTPs compared to cigarettes among smokers in Japan in 2018.

Figure 2

Relative perceptions of harmfulness of HTPs compared to cigarettes among concurrent users stratified by HTP use frequency (frequent HTP users versus infrequent HTP users). Data are weighted and adjusted. HTPs: Heated tobacco products. Frequent HTP user: at least weekly use; infrequent HTP user: less than weekly use.

Figure 3

Relative perceptions of harmfulness of HTPs compared to cigarettes among concurrent users stratified by smoking and HTP use frequency (Predominant Smokers vs. Concurrent-daily Users vs. Concurrent Non-daily Users). Data are weighted and adjusted. HTPs: Heated tobacco products. Predominant Smokers: smoke cigarettes daily and use HTP less than daily; Concurrent-daily users: smoke cigarettes and use HTP daily; Concurrent non-daily users: smoke cigarettes and use HTP less than daily.