Studies link heated tobacco to halved cigarette sales in Japan

New studies reveal that heated tobacco products (HTPs) are a key factor in significant drop in smoking rate Japan, where cigarette sales were halved in a decade.

According to “Transformation of the Tobacco Product Market in Japan, 2011–2023,” a study published in October 2024 in the peer-reviewed journal Tobacco Control, per capita and total cigarette sales in Japan fell by more than 50 percent between 2011 and 2023. This trend was relatively flat until 2015, when HTPs were introduced to the Japanese market, after which the rate of decline accelerated significantly.

“Halving the cigarette market in Japan in just over a decade is a remarkable achievement and figuring out how to replicate this type of change elsewhere should be a priority for public health research,” the study concluded.

If half of Japan’s smokers switched from combustible tobacco to HTPs, up to 12 million tobacco-related illnesses could be prevented, potentially saving the Japanese healthcare system as much as 454 billion yen ($2.9 billion), according to a study titled “Switching from Cigarettes to Heated Tobacco Products in Japan—Potential Impact on Health Outcomes and Associated Health Care Costs.”

That study was published in September 2024 in the peer-reviewed, open-access journal Healthcare (Basel).

The study’s authors recommended that Japan continue to prioritize “cost-efficient measures that promote public health and economic benefits,” including encouraging smokers to switch to reduced-risk products, increasing awareness of health risks, and adopting a harm-based taxation approach.

International health advocates called on other countries to consider emulating Japan’s adoption of harm reduction as a tobacco control measure.

Dr. Lorenzo Mata, president of Philippine health advocacy group Quit for Good, said newer smoke-free alternatives such as heated tobacco and vapes have a better chance of helping reduce smoking prevalence.

“If we really want to help smokers, education on and access to these less harmful alternatives should be prioritized,” Mata said.

In his keynote speech at the Global Tobacco and Nicotine Forum in 2023, Hiroya Kumamaru, vice director at Japan’s AOI Universal Hospital, noted that smoking was the leading cause of death in Japan in 2019, followed closely by high blood pressure, which he attributed to the country’s aging population.

“By 2019, almost one-third of male and one-quarter of female tobacco consumers were using HTPs, [which is] amazing,” Kumamaru said.

Addressing concerns over unintended effects, such as dual use or youth initiation, he pointed out that initiation or reinitiation is minimal, with surveys recording 2 percent in the first year and 1.3 percent in the second. Youth initiation in particular remains low, with no increase in initiation among younger people due to the launch of HTPs.

Japan’s ten-year transition to reduced-harm tobacco alternatives could serve as a replicable model for other nations as the global health community strives to curb smoking-related diseases.