Heated tobacco products keep people smoking, too

Heated tobacco products (HTP) are promoted as a way to “switch completely” (i.e., quit) smoking cigarettes. While these products have not yet been widely used in the US, the tobacco companies, beginning with PMI’s IQOS, have built significant markets for them in Japan. Now Satomi Odani and colleagues at the Osaka International Cancer Institute have provided information on how HTP affect smoking behavior. The title of their paper says it all: Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan.

They followed 7044 Japanese adults forward in time for two years and examined how using a HTP at the beginning of the study predicted smoking a year later. (Such longitudinal studies in which people are followed forward in time are the strongest kind of epidemiological study.) They found, overall, that smokers who used HTP were no more likely to stop smoking than smokers who didn’t use HTP. In other words, as used in the real world, HTP do not help smoker quit.

The findings among people who were trying to quit were even more troubling. Among smokers who were actually trying to quit (as evidenced by using evidence-based cessation measures, including counseling or smoking cessation medications) HTP use cut the likelihood of quitting smoking by a third (adjusted prevalence ratio, APR=0.61).

In addition, the effects of HTP on relapse to cigarette smoking are worse than the title of the paper indicates. Long-term former smokers who used HTP were more likely to relapse to smoking.

These analyses controlled for level of addiction, age, sex, gender, and a variety of other demographic variables.

The authors conclude, “HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.”

This result is not surprising because the tobacco companies started developing these “new” tobacco products in the late 1980s to hold on to health-concerned smokers (HTP, e-cigs, NRT) who, absent these products, would have stopped smoking. In contrast to what “harm reduction” advocates and some agencies, including the FDA, argue, these products were not developed to actually reduce harm or as smoking cessation aids. The tobacco companies developed them to hold on to customers. This study adds to the evidence that the companies have been exceptionally successful at using HTP to do just that: to hold on to customers.

It’s time for regulatory agencies to start basing decision making on actual scientific evidence rather than industry myths that sometimes are repeated by health professionals who are not considering all the evidence.

Here is the abstract

Background Heated tobacco products (HTPs) are often marketed as a safer alternative to help cigarette smokers quit. We investigated the link between HTP use and smoking cessation and relapse.

Methods 7044 adults (≥20 years old) with at least two observations over three waves (2019–2021) of a longitudinal, nationwide, internet-based survey were classified into current (past 30-day), former and never cigarette smokers. ≥1 month and ≥6 months smoking cessation and smoking relapse at 1-year follow-up were assessed in relation to current HTP use at baseline. Generalised estimating equation models were weighted to account for population differences between HTP users and non-users. Adjusted prevalence ratios (APRs) were computed within population subgroups.

Results At baseline, 17.2%, 9.1% and 6.1% of the respondents were current cigarette smokers, HTP users and dual users, respectively. Among current established smokers (having smoked regularly, n=1910), HTP use was significantly associated with a decreased likelihood of ≥1 month cessation within those who reported having used evidence-based cessation measures (APR=0.61), smoking 20+ cigarettes per day (APR=0.62), high school education or less (APR=0.73) and fair/poor health (APR=0.59). Negative associations were also seen for ≥6 months cessation among those aged 20–29 years (APR=0.56) and full-time workers (APR=0.56). Among former smokers (n=2906), HTP use was associated with smoking relapse within those who last smoked >1 year ago (APR=1.54), among women (APR=1.61), those aged 20–29 years (APR=2.09), those reporting high school education or less (APR=2.36), those who were unemployed/retired (AOR=3.31) and never/non-current alcohol users (APR=2.10).

Conclusion HTP use did not help smokers quit or prevent former smokers from relapsing. HTPs should not be recommended as a cessation aid.

The full citation is: Odani S, Tsuno K, Agaku IT, Tabuchi T. Heated tobacco products do not help smokers quit or prevent relapse: a longitudinal study in Japan. Tob Control. 2023 Feb 27:tc-2022-057613. doi: 10.1136/tc-2022-057613. Epub ahead of print. PMID: 36849258. It is available here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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