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Correspondence to Satomi Odani, Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan; [email protected]

WHAT IS ALREADY KNOWN ON THIS TOPIC

  • Heated tobacco products (HTPs) are commonly used by cigarette smokers who attempt to quit smoking despite there being no evidence to support the utility of HTPs as a cessation aid.

WHAT THIS STUDY ADDS

  • HTP use was associated with decreased smoking cessation among established cigarette smokers who had used evidence-based cessation measures (counselling services/prescribed medications/over-the-counter nicotine replacement therapy products), those with a heavy smoking habit, with less education, with full-time work, with poorer health and among younger smokers.

  • HTP use also led former cigarette smokers to relapse to smoking among those who were long-time cigarette quitters, women, younger, less educated, unemployed or retired, and non-users of alcohol.

  • HTPs could serve as a disincentive to successful quitting.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

  • HTPs should not be recommended as a cessation aid.

  • Educational interventions, in combination with intensified implementation of evidence-based tobacco control measures, are essential to eliminate the misperception that HTPs can be used as a smoking cessation aid and to denormalise the use of all types of tobacco, including HTPs.

Introduction

The increasing use of heated tobacco products (HTPs) has made tobacco control more challenging than ever before. The most common product, IQOS (Philip Morris International), has been approved by the US Food and Drug Administration for marketing as a ‘reduced exposure’ product on the grounds that the product has a lower level of specific harmful constituents than conventional cigarettes.1 2 Although this does not necessarily translate to a reduced risk of diseases,1 3 the tobacco industry has marketed HTPs as a ‘cleaner alternative to cigarettes’ and ‘reduced risk product’.4–6 Such claims may lead the public to perceive HTPs as a safe, effective aid for smoking cessation and undermine the public health efforts to denormalise the use of all types of tobacco.4 5 7

HTPs are already available in more than 40 countries, covering all regions of the world.8 Of those, Japan is the biggest market, where HTPs have established themselves as the second most used tobacco product.9 The increasing trend in HTP use has, however, levelled off in Japan in the recent...

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