Japan’s Leading Position in the Tobacco Harm Reduction World

    Japan has halved its cigarette sales in a decade, in what tobacco harm reductionists call a “globally unprecedented” shift. What can this be attributed to, in a country where 79 percent of men aged 20-29 once smoked?

    A new Global State of Tobacco Harm Reduction (GSTHR) briefing paper reviews this success story. It cites a number of contributing factors to the dramatic fall in cigarette sales, some held in common with other wealthy countries. But it makes clear that what sets Japan apart, in achieving a world-leading 52 percent decline during this period, is the widespread popularity of heated tobacco products (HTP).

    HTP are electronic devices that heat tobacco sticks—enough to produce vapor, but not enough to burn them. The inhaled vapor provides nicotine with fewer toxins than are found in smoke from combustion, making HTP substantially safer than cigarettes. Many people have used HTP to switch entirely, or to reduce the amount they smoke. 

    “Japan provides a unique example of what happens when people are given the opportunity to switch from an inherently dangerous nicotine delivery system, cigarettes, to one with significantly lower risk,” David MacKintosh, a director of Knowledge Action Change (KAC), which runs the GSTHR project, told Filter.

    Hitoshi Tanaka is part of this trend. He used to smoke exclusively, but now often replaces the cigarettes he would have smoked. 

    Currently, the majority of Japanese people who use HTP are “dual users” of both HTP and cigarettes, the briefing paper notes. Dual use is sometimes seized upon by opponents of tobacco harm reduction as evidence of products’ ineffectiveness. But this ignores how it is often part of a journey toward smoking cessation—and how smoking fewer cigarettes, while not optimal, reduces harms compared to smoking more. Japan is smoking much less.

    Japanese resident Hitoshi Tanaka is part of this trend. He used to smoke exclusively, but now often replaces the cigarettes he would have smoked with his HTP device. He didn’t necessarily intend to make this transition, but has done so principally because of regulatory factors.

    “The government has raised the tax on paper cigarettes and narrowed the range of environments in which cigarettes can be smoked,” Tanaka told Filter

    “In such an environment, people have no choice but to switch to heated tobacco products,” he said, adding that the decreasing number of spaces where he’s permitted to smoke is the main reason “I now carry both.”

    Still, Tanaka acknowledged that “health concerns” and the “safety” of HTP are also among major possible reasons why “Japanese people have switched.”

    HTP were first introduced in Japan in 2014. A single brand—IQOS, made by Philip Morris International (PMI)—was initially on the market. By 2016, more brands had launched and the products were available nationwide. And by 2018, one in four tobacco users was using HTP.

    In 2015, the GSTHR briefing states, cigarette sales stood at “around 182.34 billion units.” By 2023, this figure had fallen to 88.1 billion; sales of the tobacco sticks used with HTP, meanwhile, had risen to 72 billion units, strongly indicating substitution. Based on industry data, GSTHR projects that in 2024, HTP sales will very nearly match cigarette sales.

    Other safer nicotine options, like vapes and nicotine pouches, are regulated as medicinal products in Japan, and unavailable in practice. It makes sense that HTP sales would thrive without competition from harm reduction alternatives.

    “The retail environment create a ‘safe place’ for smokers to have a discussion with knowledgeable, nonjudgemental and empathetic salespeople.”

    But Derek Yach, formerly the founding director of the Foundation for a Smoke-Free World and executive director for noncommunicable diseases at the World Health Organization, thinks the reasons run deeper.

    “The retail environment in IQOS stores create a ‘safe place’ for adult smokers seeking to end smoking to have a discussion with knowledgeable, nonjudgemental and empathetic salespeople,” he told Filter. “It allows smokers to feel valued, breaking the stigma and shunning many people feel.”

    Yach, who has visited stores in Japan, said the retailers’ success is notable. “It would be valuable for PMI to share the behavioral research that underpinned store design,” he continued. “I feel that researchers focused on tobacco harm reduction should visit IQOS stores. They will learn a lot about determinants of success from salespeople and consumers that rarely make it into publications.”  

    Unlike countries such as the United Kingdom, where government policies have actively promoted smoking cessation through harm reduction, Japan has seen a more laissez-faire approach. Product migration has happened with relatively little government involvement.

    Importantly, there are no restrictions on advertising HTP as being less harmful than cigarettes (though the industry self-imposes a rule of marketing to adults only). And in 2021, the GSTHR paper also notes, taxation on cigarettes “was more than double that of HTP,” even if that financial incentive has often not been passed on to HTP consumers.

    “The Japanese people are likely protected by language and culture from the inundation of misinformation on nicotine.”

    “It should be no surprise that consumers will move to products that give them better value,” David Sweanor, an industry expert who chairs the advisory board of the Centre for Health Law, Policy and Ethics at the University of Ottawa, told Filter.

    “The Japanese people are likely protected by language and culture from the inundation of misinformation on nicotine, and by having a less developed anti-tobacco infrastructure,” he added.

    In the absence of these obstacles, and with a government that neither opposes nor endorses tobacco harm reduction, Japan is a clear example of how consumer preferences can drive public health wins, Sweanor believes.

    The GSTHR briefing references a poll conducted by the Foundation for a Smoke-Free World in 2019, when Yach was its director (the organization recently rebranded as Global Action to End Smoking). This found that “concern about the health risks to others associated with second-hand smoke from cigarettes” was a key factor in Japanese people switching.  

    “Based on talking to Japanese smokers seeking to switch, it was my impression that many cited concerns they had about the health of family members exposed to smoke and a dislike for odor left by smoke as a reason to stop smoking,” Yach said. “Their own health being a lower priority.”  

    The GSTHR briefing cites this concern for others’ wellbeing, as well as an openness to embracing new technology, as characteristics of Japanese culture that have sped the rise of HTP.

    “We should all be interested in learning from those countries seeing dramatic drops in cigarette sales.”

    Whatever the reasons, Japan has established an eye-opening position in the global tobacco harm reduction landscape—alongside other countries that have taken quite different paths to increased smoking cessation, such as Sweden (with snus) and the UK (with vapes).

    “In situations where there is a broader range of safer nicotine products available, the potential for massive public health gains is clear,” MacKintosh said.

    “Every country faces their own challenges and context, but all have the opportunity to help reduce premature deaths from smoking by enabling people to make better, healthier choices,” he concluded. “We should all be interested in learning from those countries seeing dramatic drops in cigarette sales, and those who are on track to achieve smoke-free status.”



    Photograph (cropped) of IQOS store in Japan by Tokumeigakarinoaoshima via Wikimedia Commons/Creative Commons 4.0

    The Influence Foundation, which operates Filter, has received grants from Global Action to End Smoking (formerly the Foundation for a Smoke-Free World), from KAC and from PMI. Filter’s Editorial Independence Policy applies.

    • Kiran is a tobacco harm reduction fellow for Filter. She is a writer and journalist who has written for publications including the Guardian, the Telegraph, I Paper and the Times, among many others. Her book, I Can Hear the Cuckoo, was published by Gaia in 2023. She lives in Wales.

      Kiran’s fellowship is supported by an independently administered tobacco harm reduction scholarship from Knowledge-Action-Change—an organization that has separately provided restricted grants and donations to Filter.

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