Science and Practice for Heated Tobacco Products Japan as
a Test Bed for Novel Tobacco Products
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Takahiro Tabuchi
Cancer Control Center, Osaka International Cancer Institute, Osaka,
Japan
ISBN 978-981-33-4503-4 e-ISBN 978-981-33-4504-1
https://doi.org/10.1007/978-981-33-4504-1
© The Editor(s) (if applicable) and The Author(s), under exclusive
license to Springer Nature Singapore Pte Ltd. 2021
This work is subject to copyright. All rights are reserved by the
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Acknowledgments
I will begin this book with some words of gratitude. I am deeply
indebted to Chihiro Haraguchi and Saki Kasai of Springer Japan. This
book would not have been possible without all the activities and
thoughts I was able to share with my colleagues in tobacco control,
public health, epidemiology, and other related fields. I thank Dr. Julia
Mortimer and Mr. Peter L Jaeger for their English language editing. This
book was supported by the Japan Society for the Promotion of Science
(KAKENHI Grant JP18H03062). Finally, I give my thanks to my wife
Makoto and my son Taiki for their spiritual support, which is constant
and unflagging.
Contents
1 Introduction
1.1 Foreword
1.2 What Is the Big Problem with New Tobacco Products?
1.3 What we Must Understand about New Tobacco Products
1.4 The Very Image of HTPs Is Dubious
References
2 Tobacco Products in Japan Including a History of Heated Tobacco
Products
2.1 New Tobacco Products Are Taking Japan by Storm
2.2 No Innovation:They Have Been Around a Long Time
References
3 The JASTIS Project:Product Use Status in Japan
3.1 New Tobacco Products Got their Start from “Ame-Talk”:
Google Trends Study
3.2 New Tobacco Product Use in Japan:The JASTIS Study
3.3 Why Are New Tobacco Products So Popular?
3.4 Japan:The Global Test Site for IQOS
References
4 Marketing Strategy for Tobacco Products in Japan
4.1 The Japanese Love a New Gadget
4.2 The Japanese Public:Manipulated with Imagery and Led to
Misunderstanding
4.3 The Risks of Tobacco the Media Would Not Report, and Why
Not
4.4 The Tobacco Companies’ Outrageous Insult to Smokers
References
5 Substances in Novel Tobacco Products
5.1 The Harmful Substances in Tobacco Smoke:Basic
Information from Public Health Perspective
5.2 The Harmful Substances in HTP Aerosol
5.3 The Many Unresearched Substances in HTP Aerosol
5.4 The Harmful Substances in e-Cigarette Aerosol
References
6 Health Effect
6.1 Risk of Cancer
6.1.1 Reason One
6.1.2 Reason Two
6.1.3 Reason Three
6.2 Risk of Circulatory Disorders
6.3 Increasing Nicotine Dependence
6.4 The Pluses and Minuses of Passive Smoke from New
Tobacco Products:Children and Family Members Are at Risk
6.5 EVALI:e-Cigarette or Vaping Product Use-Associated Lung
Injury
References
7 Social Effect
7.1 Are New Tobacco Products Cigarettes or Not?
7.2 New Tobacco Products Are Changing All the Rules
7.3 With the Introduction of New Tobacco Products, the
Difficulty Level of Tobacco Control Has Increased Sharply
7.4 New Tobacco Products Have Brought New Problems to
Society
7.5 How Our Attitudes Have Been Warped by the Tobacco
Industry
7.6 Fanning the Flames of Confrontation to Keep Tobacco Alive
References
8 Interpretation of Risks of Novel Tobacco Products, Including
Harm Reduction Theory
8.1 How Can We Interpret the Risks of New Tobacco Products
8.2 Will we Ever Really Know the Health Risks of New Tobacco
Products?
8.3 The Risks of e-Cigarettes:Are They Really a Means of “Harm
Reduction”?
8.3.1 It Has Not Been Clearly Established that e-Cigarettes
Are Less Harmful than Conventional Cigarettes
8.3.2 It Is Not Known if e-Cigarettes Can Help People Quit
Smoking Conventional Cigarettes
8.3.3 E-Cigarettes Have Their Own Issues
8.4 What Is Optimal for Comparing with New Tobacco
Products?
References
9 Suggestions for Practice Regarding Novel Tobacco Product Use
Patterns
9.1 Cessation in the Era of New Tobacco Products
9.1.1 Essential Skills to Ensure that Patients Who Have Quit
Remain Tobacco-Free
9.1.2 For Smokers
9.1.3 For Medical Doctors
9.1.4 For People Who Help People Quit
References
10 Policy Implication Including Interference in Tobacco Control
Measures with New Tobacco Products
10.1 For the People Who Make the Rules for our Society
(Legislators and Bureaucrats)
10.2 View of the World Health Organization
10.3 View from IARC Classifications:“Tobacco Smoke” as a
Carcinogen
10.4 Can we Trust the Tobacco Companies?:Interference in
Tobacco Control Measures with New Tobacco Products
References
11 Conclusions
11.1 Implication for Future Work
11.2 The World Is Not Logical nor Right
11.3 A Matter of Degree
11.3.1 So, in the End, What Should we Do?
Index
List of Figures
Fig.1.1 Tobacco companies altered cigarettes using 9 technical tricks
Fig.1.2 Japan tobacco TV commercial
Fig.1.3 IQOS store in Central Tokyo
Fig.1.4 Pamphlets on HTPs
Fig.1.5 The questions on everyone’s minds about HTPs
Fig.2.1 Structural diagram of heated tobacco product
Fig.2.2 Structural diagram of e-cigarette
Fig.2.3 Structural diagram of paper-rolled cigarette
Fig.2.4 New tobacco products and their regulations (Photos taken by
the author’s research group, 2016–2017)
Fig.2.5 Global timeline for HTPs in the world and Japan
Fig.2.6 Comparison of accord (1998) and IQOS (2014)
Fig.3.1 Search results from Google Trends
Fig.3.2 Searches on Google Trends for new tobacco products in Japan
Fig.3.3 Trends in new tobacco product usage by Japanese adults
Fig.3.4 Countries in which IQOS is sold
Fig.3.5 Growth of market share of IQOS sticks in Japan
Fig.4.1 Heated tobacco pamphlets claiming reduced harmful
substances
Fig.4.2 Health warnings on heated tobacco pamphlets
Fig.4.3 Television programs sponsored by Japan Tobacco
Fig.4.4 Health risks as described in IQOS pamphlet
Fig. 4.5 Advertisements by tobacco companies. (a) (Internet ad for
PloomTECH by Japan Tobacco); (b) (newspaper ad for IQOS by PMI),
2020. Both advertisements appeal to smokers “if you stay at home,
please use HTPs!”
Fig.4.6 Marketing copy displayed in IQOS stores
Fig. 5.1 Tobacco smoke: harm caused and routes of causality (Source:
US Surgeon General Report 2014)
Fig. 5.2 Mechanism of how smoking causes circulatory disorders
(Source: Tobacco smoking and health. A report from the review
committee on the health effects of tobacco smoking. 2016.
http://www.mhlw.go.jp/stf/shingi2/0000135586.html)
Fig.5.3 Harmful substances in HTPs and their risks
Fig.5.4 Chemical substances emitted by IQOS and cigarettes (μg/stick)
Fig.5.5 Blood nicotine concentration after smoking.Source:Picavet P,
Haziza C, Lama N et al.Nicotine and Tobacco Research 2016; 18:557-
563
Fig.5.6 Particulate matter and harmful substances absorbed by passive
smoking, a comparison of HTPs to combustible cigarettes
Fig.5.7 Types and quantities of aldehydes in aerosol of e-cigarettes sold
in Japan
Fig. 6.1 Difference in Brain Reactive Function upon Receiving Chocolate
(a) non-smoker (n=43), (b) smoker (n=43). Source: J Peters et al.,
American Journal of Psychiatry 168:540–549, 2011
Fig.7.1 “No-smoking” sign displayed at the 2018 FIFA Soccer World
Cup.Photo from the Nagoya Anti-Tobacco Support Group “The
Committee to Protect Children from Tobacco, Aichi”
Fig.7.2 The MPOWER criteria for evaluating world tobacco control
performance
Fig.7.3 A doctor recommends smoking in an advertisement (USA,
1931).Source:Stanford Research into the Impact of Tobacco
Advertising (SRITA), Tobacco Advertisement Database
Fig.7.4 Japanese smoking rates by education level (%, age 25–64, male/
female).Source:Ministry of Health, Comprehensive Survey of Living
Conditions, 2010, T Tabuchi, N Kondo, Journal of Epidemiology 2017;
27:186-192
Fig.8.1 Relationship between cigarettes and ischemic heart disease
(paper-rolled cigarettes per day).Source:TF Pechacek, S Babb BMJ
2004:328(7446):980–3 (Edited)
Fig.10.1 Trend in Japan tobacco profits.Source:Mark A Levin, “Five
Important Things to Know About Japan Tobacco Inc.,” summary
presentation of November 2014 keynote lecture at eighth Annual
Meeting of the Japan Society for Tobacco Control, Japanese Journal of
Tobacco Control, Vol.10, No.1, pp.13-18, Spring 2015 (in Japanese)
Fig.10.2 JT’s overseas operations and cigarette sales outside Japan.
Source:JT website
Fig.10.3 Countries and regions where JT has #1 market share.Source:
M Eriksen, J Mackay, N Schluger et al.The Tobacco Atlas, Fifth Edition:
Revised, Expanded, and Updated.Atlanta, Georgia, USA.American
Cancer Society, 2015
Fig.11.1 Analytical models for examination of health effect from HTPs
suggesting three possible comparisons
List of Tables
Table 3.1 Sales of heated tobacco products by year
Table 3.5 Reasons for using HTPs
Table 3.6 Reasons for using e-cigarettes
Table 3.2 Adjusted prevalence of current heated tobacco (HTP) use (use
in previous 30 days) from 2015 to 2019 in Japan
Table 3.3 Adjusted prevalence of current heated tobacco (HTP) use in
previous 30 days by product types from 2015 to 2019 in Japan
Table 3.4 Characteristics by percentage of IQOS users
Table 4.1 Cancer preventive factors
Table 4.2 Cancer risk factors
Table 5.1 Comparison of chemical substances in IQOS aerosol and
cigarette smoke, results from tobacco companies, and independent
research organizations
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021
T. Tabuchi, Science and Practice for Heated Tobacco Products
https://doi.org/10.1007/978-981-33-4504-1_1
1. Introduction
Takahiro Tabuchi1
(1) Cancer Control Center, Osaka International Cancer Institute, Osaka,
Japan
1.1 Foreword
Advertisements for the tobacco industry’s new heated tobacco products
(HTPs) line the windows of Japan’s convenience stores and information
racks overflow with pamphlets extolling the virtues of HTPs. Are the
Japanese aware that this phenomenon is not global but is confined to
Japan.
In 2014, the HTP “IQOS ” went on sale as a limited release in a few
cities in Japan and Italy, and in 2016, Japan became the first country in
the world to offer IQOS for sale nationally. As of October 2016, Japanese
sales accounted for 96% of IQOS volume globally; almost all the IQOS
use in the world was in Japan. In other words, Japan had become the
world’s test bed for the so-called novel tobacco products known as
HTPs.
The only readily available information on HTPs is that disseminated
by the tobacco industry. As a result, many Japanese now believe exactly
what the tobacco industry wants them to believe. In fact, tobacco
companies have been deliberately operating a promotional campaign
designed to spread the misconception that HTPs are harmless (no harm
or no tar). I myself have been approached by many people who ask, in
all seriousness, questions such as “heated tobacco is basically harmless,
isn’t it?” or “since heated tobacco is safe, it’s okay to smoke it in front of
children, right?” I am shocked by how many people have
misunderstood the reality of the situation.
