BALANCE BETWEEN REGULATION AND HARM REDUCTION

The latest results from the Global Adult Tobacco Survey (GATS) 2023, released a month ago, revealed that smoking prevalence has increased from 0.8% in 2011 to 5.8% in 2023.

GATS 2023 was published by the Institute of Public Health operating at the Ministry of Health in cooperation with the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC).

Among smokers aged 15 to 24, the percentage of e-cigarette users was 8.6% in 2023, up from 1.1% in 2011.

Additionally, the study also found an increase in the prevalence of concurrent use of tobacco and e-cigarettes from 0.8% in 2011 to 3.9%.

In line with the WHO Framework Convention on Tobacco Control (FCTC), the Ministry of Health enacted the Public Health Tobacco Control Act 2024 (Act 852) on February 2 this year, with enforcement beginning in June, to help reduce the use of vaping products among youth.

In light of the disturbing findings of GATS 2023 and the proactive approach of the Ministry of Health, it becomes necessary to examine how Japan is approaching the issue of alternatives to traditional smoking.

How Japan is Dealing with the Alternatives

In 2018, the Tokyo Metropolitan Assembly introduced a more stringent anti-smoking ordinance compared to national regulations in Japan.

The aim was to reduce passive smoking and create a tobacco-free environment for the 2020 Olympic Games.

The smoking ban in Tokyo follows a similar amendment to the Health Promotion Act, which was discussed in parliament.

The Tokyo ordinance will cover about 84% of the city’s restaurants and bars, while the revised national law is set to regulate about 45% of such establishments.

Although the regulation is stricter than national laws, it does not introduce a total smoking ban.

Some institutions, such as universities, hospitals and government offices, will have more relaxed rules, allowing smoking in designated outdoor areas. Meanwhile, gyms, hotels and some restaurants will have more lenient restrictions, as smoking will only be banned indoors. Designated rooms with smoke-free devices will also be available.

Tackling passive smoking was also an urgent matter for Japan, which, although a member of the World Health Organization (WHO) Convention on Tobacco Control, does not have a nationwide law banning smoking in public places.

According to a 2017 WHO report, Japan was among the worst countries in terms of smoke-free compliance.

According to local Japanese reports from 2017, as with the amendment to the Health Promotion Act, the new regulation does not impose any penalties for the use of heating products that do not require combustion, as there is currently no scientific evidence to prove the negative health effects of passive smoking.

As a result, customers will be able to use e-cigarettes while eating in designated smoking areas in restaurants and bars, under the so-called “bunen” system.

Scientific case study

The Japanese case study shows the effectiveness of introducing smoke-free products in reducing the prevalence of smoking.

According to data collected in 2019 by the Japan National Health and Nutrition Survey (NHNS), the smoking rate among Japanese adults is about 16.7%.

Further research showed that 27.1% of men and 7.6% of women use tobacco products at least once a month.

According to the same NHNS, following the introduction of heated tobacco products (HTP), there was a significant decline in the prevalence of cigarette smoking among adults.

In 2014, before these products were introduced, 20% of adults admitted to smoking daily or occasionally.

By 2019, the percentage of smokers had dropped to 13%.

The study also revealed that the vast majority of heated tobacco users, specifically 76% in 2019, did not admit to smoking cigarettes.

Tobacco Heating Systems (THS) were first introduced in Nagoya, Japan in late 2014 as part of a city pilot, and were rolled out nationwide in 2016.

A literature review conducted by PMI Science following the introduction of the HTP program in 2015 found that “cigarette sales began to decline significantly in every region in Japan.

“Before the law was implemented nationwide, overall tobacco sales in Japan declined by an average of 1.8% between 2011 and 2015.”

The study also found that after the introduction of HTP tobacco products in Japan, overall tobacco sales continued to follow the same trend.

Notably, cigarette sales declined even more sharply following the introduction of nationwide smoking devices such as IQOS: an average annual decline of 9.5% between 2015 and 2018.

Achieving tangible results

Regulations in Japan distinguish between traditional and traditional cigarettes.

HTP devices heat the tobacco sufficiently to release an aerosol containing nicotine without burning the tobacco.

Because tobacco is heated rather than burned, there is no smoke produced and the levels of harmful and potentially harmful chemicals in the aerosols generated can be significantly lower compared to cigarette smoke.

In an air quality assessment study published in the journal MDPI, researchers found that levels of nicotine and other chemicals measured during use were very low and below established safety limits, meaning indoor air quality was within acceptable limits.

Compared to cigarettes and other products that produce smoke through combustion, heated tobacco had a much smaller impact on indoor air quality and also contained much lower levels of harmful substances.

Jeremy Custance, PMI’s communications director for East Asia and Australia, commented: “Regulators and the public need accurate product information.

“They need to understand that there is a fundamental difference (between HTP) and cigarettes.

“One of the reasons Japan has adopted these HTPs is hygiene – there is no ash, no smell and no smoke, making it a better option for the people around you compared to smoking cigarettes,” he added.

He further explained that HTP’s popularity among Japanese consumers has increased because the country is known for its high personal culture and consideration for others.

“IQOS aerosol contains on average 95% less harmful ingredients than cigarettes.

“It makes a big difference and impact on people who decide to continue smoking,” Custance said.

He added that PMI is urging the industry to move towards smoke-free products in an attempt to phase out flammable substances.

“When IQOS was introduced, we saw an accelerated decline in cigarette sales in Japan, about five times faster than before.”

According to the latest report by the Japanese Tobacco Institute, the introduction of HTP resulted in a significant decrease in cigarette consumption by as much as 44% in just five years.

This decline represents the largest reduction in cigarette consumption ever observed in Japan.

“Tobacco regulation should be based on a continuum of risk. For example, the ‘most harmful’ product in this case, the combustible cigarette, whereas non-combustible products like HTP drastically reduce harmful chemicals – so it doesn’t make sense to regulate them in the same way when they are scientifically, fundamentally different,” Custance stressed.