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Heat-not-burn tobacco, electronic cigarettes, and combustible cigarette use among Japanese adolescents: a nationwide population survey 2017.
BMC Public Health. 2020 May 20; 20(1):741.BP

Abstract

BACKGROUND

From among the global public health concerns, smoking remains one of the most crucial challenges. Especially for adolescents, the increase in the use of electronic cigarettes is controversial, as its use may lead to established smoking. In Japan, where a unique tobacco regulation system exists, the heat-not-burn tobacco market has been growing. However, the prevalence and association of combustible cigarettes and new tobacco-related products have not yet been closely investigated among Japanese adolescents. This study aimed to clarify the prevalence of smoking among adolescents, including new types of tobacco-related products, and to compare the characteristics of their users.

METHODS

The 2017 Lifestyle Survey of Adolescents is a nationally-representative survey collected in Japan. From the national school directory, 98 junior high schools and 86 high schools were randomly sampled throughout Japan. The students completed an anonymous questionnaire at school. We calculated the prevalence of use for each type of tobacco product. Then, the use of a combination of products and the characteristics of different types of products were examined.

RESULTS

In total, 64,152 students from 48 junior high schools and 55 high schools were included the analysis (school response rate = 56%, Mage = 15.7 years, 53.9% boys). The age-adjusted rate of ever (current) use of electronic cigarettes was 2.1% (0.7%) in junior high school and 3.5% (1.0%) in high school; that of combustible cigarettes was 2.6% (0.6%) in junior high school and 5.1% (1.5%) in high school. The rate of heat-not-burn tobacco use was lower relative to other products: 1.1% (0.5%) in junior high school and 2.2% (0.9%) in high school. An examination of the combined use of the three products identified a high number of dual users. Comparisons between different types of users indicated different backgrounds for combustible cigarette users and new product users.

CONCLUSIONS

The prevalence of new tobacco-alternative products is growing in popularity among Japanese adolescents. Dual use is common, and many adolescents use new products only. Moreover, e-cigarettes might attract a broader range of groups to smoking. Continuous monitoring and research are needed to investigate their influence as a possible gateway to tobacco smoking.

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Authors+Show Affiliations

Kuwabara Y
Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Nishi-machi 86, Yonago-shi, Tottori, 683-8503, Japan. ykuwabara@tottori-u.ac.jp.
Kinjo A
Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Nishi-machi 86, Yonago-shi, Tottori, 683-8503, Japan.
Fujii M
Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Nishi-machi 86, Yonago-shi, Tottori, 683-8503, Japan.
Imamoto A
Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Nishi-machi 86, Yonago-shi, Tottori, 683-8503, Japan.
Osaki Y
Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Nishi-machi 86, Yonago-shi, Tottori, 683-8503, Japan.
Jike M
Department of Public Health, School of Medicine, Nihon University, Itabashi-ku, Tokyo, Japan.
Otsuka Y
Department of Public Health, School of Medicine, Nihon University, Itabashi-ku, Tokyo, Japan.
Itani O
Department of Public Health, School of Medicine, Nihon University, Itabashi-ku, Tokyo, Japan.
Kaneita Y
Department of Public Health, School of Medicine, Nihon University, Itabashi-ku, Tokyo, Japan.
Minobe R
National Institute of Alcoholism, Kurihama National Hospital, Yokosuka, Kanagawa, Japan.
Maezato H
National Institute of Alcoholism, Kurihama National Hospital, Yokosuka, Kanagawa, Japan.
Higuchi S
National Institute of Alcoholism, Kurihama National Hospital, Yokosuka, Kanagawa, Japan.
Yoshimoto H
Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, Majors of Medical Science, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Kanda H
Department of Public Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-shi, Okayama, Japan.

MeSH

AdolescentAdolescent BehaviorElectronic Nicotine Delivery SystemsFemaleHot TemperatureHumansJapanLife StyleLongitudinal StudiesMalePrevalenceSchoolsSmokingStudentsSurveys and QuestionnairesTobaccoTobacco ProductsTobacco SmokingVaping

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32434517

Citation

Kuwabara, Yuki, et al. "Heat-not-burn Tobacco, Electronic Cigarettes, and Combustible Cigarette Use Among Japanese Adolescents: a Nationwide Population Survey 2017." BMC Public Health, vol. 20, no. 1, 2020, p. 741.
Kuwabara Y, Kinjo A, Fujii M, et al. Heat-not-burn tobacco, electronic cigarettes, and combustible cigarette use among Japanese adolescents: a nationwide population survey 2017. BMC Public Health. 2020;20(1):741.
Kuwabara, Y., Kinjo, A., Fujii, M., Imamoto, A., Osaki, Y., Jike, M., Otsuka, Y., Itani, O., Kaneita, Y., Minobe, R., Maezato, H., Higuchi, S., Yoshimoto, H., & Kanda, H. (2020). Heat-not-burn tobacco, electronic cigarettes, and combustible cigarette use among Japanese adolescents: a nationwide population survey 2017. BMC Public Health, 20(1), 741. https://doi.org/10.1186/s12889-020-08916-x
Kuwabara Y, et al. Heat-not-burn Tobacco, Electronic Cigarettes, and Combustible Cigarette Use Among Japanese Adolescents: a Nationwide Population Survey 2017. BMC Public Health. 2020 May 20;20(1):741. PubMed PMID: 32434517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heat-not-burn tobacco, electronic cigarettes, and combustible cigarette use among Japanese adolescents: a nationwide population survey 2017. AU - Kuwabara,Yuki, AU - Kinjo,Aya, AU - Fujii,Maya, AU - Imamoto,Aya, AU - Osaki,Yoneatsu, AU - Jike,Maki, AU - Otsuka,Yuichiro, AU - Itani,Osamu, AU - Kaneita,Yoshitaka, AU - Minobe,Ruriko, AU - Maezato,Hitoshi, AU - Higuchi,Susumu, AU - Yoshimoto,Hisashi, AU - Kanda,Hideyuki, Y1 - 2020/05/20/ PY - 2019/10/14/received PY - 2020/05/13/accepted PY - 2020/5/22/entrez PY - 2020/5/22/pubmed PY - 2020/10/21/medline KW - Adolescents KW - Cigarette smoking KW - E-cigarettes KW - Heat-not-burn tobacco KW - Prevalence KW - Smoking KW - Tobacco use SP - 741 EP - 741 JF - BMC public health JO - BMC Public Health VL - 20 IS - 1 N2 - BACKGROUND: From among the global public health concerns, smoking remains one of the most crucial challenges. Especially for adolescents, the increase in the use of electronic cigarettes is controversial, as its use may lead to established smoking. In Japan, where a unique tobacco regulation system exists, the heat-not-burn tobacco market has been growing. However, the prevalence and association of combustible cigarettes and new tobacco-related products have not yet been closely investigated among Japanese adolescents. This study aimed to clarify the prevalence of smoking among adolescents, including new types of tobacco-related products, and to compare the characteristics of their users. METHODS: The 2017 Lifestyle Survey of Adolescents is a nationally-representative survey collected in Japan. From the national school directory, 98 junior high schools and 86 high schools were randomly sampled throughout Japan. The students completed an anonymous questionnaire at school. We calculated the prevalence of use for each type of tobacco product. Then, the use of a combination of products and the characteristics of different types of products were examined. RESULTS: In total, 64,152 students from 48 junior high schools and 55 high schools were included the analysis (school response rate = 56%, Mage = 15.7 years, 53.9% boys). The age-adjusted rate of ever (current) use of electronic cigarettes was 2.1% (0.7%) in junior high school and 3.5% (1.0%) in high school; that of combustible cigarettes was 2.6% (0.6%) in junior high school and 5.1% (1.5%) in high school. The rate of heat-not-burn tobacco use was lower relative to other products: 1.1% (0.5%) in junior high school and 2.2% (0.9%) in high school. An examination of the combined use of the three products identified a high number of dual users. Comparisons between different types of users indicated different backgrounds for combustible cigarette users and new product users. CONCLUSIONS: The prevalence of new tobacco-alternative products is growing in popularity among Japanese adolescents. Dual use is common, and many adolescents use new products only. Moreover, e-cigarettes might attract a broader range of groups to smoking. Continuous monitoring and research are needed to investigate their influence as a possible gateway to tobacco smoking. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/32434517/Heat_not_burn_tobacco_electronic_cigarettes_and_combustible_cigarette_use_among_Japanese_adolescents:_a_nationwide_population_survey_2017_ DB - PRIME DP - Unbound Medicine ER -