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Article

Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey

1
Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
2
Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
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Division of Cancer Prevention and Population Sciences, Department of Health Behaviors, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
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Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Division of Tobacco Policy Research, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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Japan Cancer Society, 13th Floor, Yurakucho Center Bldg. 2-5-1, Yurakucho, Chiyoda-ku, Tokyo 100-0006, Japan
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Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, ON N6G 4X8, Canada
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Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
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Ontario Tobacco Research Unit, Toronto, ON M5S 2S1, Canada
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Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
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Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
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Cancer Control Center, Osaka International Cancer Institute, Chome-1-69 Otemae, Chuo Ward, Osaka 541-8567, Japan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(7), 2394; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072394
Received: 9 March 2020 / Revised: 27 March 2020 / Accepted: 29 March 2020 / Published: 1 April 2020
In Japan, the tobacco industry promotes heated tobacco products (HTPs) as a reduced-risk tobacco product. This study examines: (1) smokers’ harm perceptions of HTPs relative to combustible cigarettes; (2) differences in relative harm perceptions between exclusive smokers and smokers who use HTPs (concurrent users) and between concurrent users based on frequency of product use; and (3) if smokers who were exposed to HTP advertising hold beliefs that are consistent with marketing messages of lower harmfulness. This cross-sectional study included 2614 adult exclusive cigarette smokers and 986 concurrent users who reported their perceptions of harmfulness of HTPs compared to cigarettes, as well as their exposure to HTP advertising in the last six months. Among all smokers, 47.5% perceive that HTPs are less harmful than cigarettes, 24.6% perceive HTPs to be equally as harmful, 1.8% perceive HTPs as more harmful, and 26.1% did not know. Concurrent users are more likely than exclusive smokers to believe that HTPs are less harmful (62.1% versus 43.8%, p < 0.0001) and less likely to report that they did not know (14.3% versus 29.4%, p < 0.0001). Frequent HTP users are more likely than infrequent users to believe that HTPs are less harmful (71.7% versus 57.1%, p ≤ 0.001). Believing that HTPs are less harmful than cigarettes was associated with noticing HTP advertising on TV (p = 0.0005), in newspapers/magazines (p = 0.0001), on posters/billboards (p < 0.0001), in stores where tobacco (p < 0.0001) or where HTPs (p < 0.0001) are sold, on social media (p < 0.0001), or in bars/pubs (p = 0.04). HTP users were significantly more likely than non-HTP users to believe that HTPs are less harmful than cigarettes, with this belief being more prominent among frequent users. Smokers who have been exposed to HTP advertising were more likely to perceive HTPs as less harmful than cigarettes. View Full-Text
Keywords: heated tobacco products; heat-not-burn; modified risk tobacco products; combustible cigarettes; perceptions of harm; risk heated tobacco products; heat-not-burn; modified risk tobacco products; combustible cigarettes; perceptions of harm; risk
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MDPI and ACS Style

Gravely, S.; Fong, G.T.; Sutanto, E.; Loewen, R.; Ouimet, J.; Xu, S.S.; Quah, A.C.K.; Thompson, M.E.; Boudreau, C.; Li, G.; Goniewicz, M.L.; Yoshimi, I.; Mochizuki, Y.; Elton-Marshall, T.; Thrasher, J.F.; Tabuchi, T. Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey. Int. J. Environ. Res. Public Health 2020, 17, 2394. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072394

AMA Style

Gravely S, Fong GT, Sutanto E, Loewen R, Ouimet J, Xu SS, Quah ACK, Thompson ME, Boudreau C, Li G, Goniewicz ML, Yoshimi I, Mochizuki Y, Elton-Marshall T, Thrasher JF, Tabuchi T. Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey. International Journal of Environmental Research and Public Health. 2020; 17(7):2394. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072394

Chicago/Turabian Style

Gravely, Shannon, Geoffrey T. Fong, Edward Sutanto, Ruth Loewen, Janine Ouimet, Steve S. Xu, Anne C.K. Quah, Mary E. Thompson, Christian Boudreau, Grace Li, Maciej L. Goniewicz, Itsuro Yoshimi, Yumiko Mochizuki, Tara Elton-Marshall, James F. Thrasher, and Takahiro Tabuchi. 2020. "Perceptions of Harmfulness of Heated Tobacco Products Compared to Combustible Cigarettes among Adult Smokers in Japan: Findings from the 2018 ITC Japan Survey" International Journal of Environmental Research and Public Health 17, no. 7: 2394. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17072394

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