The Lancet regional health. Western Pacific · 2026
Trends and transition dynamics of heated tobacco product use in Japan, 2015-2025: a repeated cross-sectional and longitudinal study.
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Odani Satomi, Tabuchi Takahiro
Аннотация
BACKGROUND: Heated tobacco products (HTPs) diffused rapidly in Japan, but transition dynamics remain unclear. We examined trends in HTP use and routes underlying its growth.
METHODS: Using data from the Japan Society and New Tobacco Internet Survey, 2015-2025, we estimated weighted prevalence of HTP use (N = 161,583). Sex- and age-standardised prevalence was used to estimate segmented trends with a 2018 knot. Among respondents observed in consecutive years (93,540 pairs), we fitted a multinomial transition model across five states (Never, Non-current, Cigarette-only, HTP-only, and Dual use) and decomposed changes in standardised HTP prevalence into four categories: uptake from Never/Non-current states, switching from Cigarette-only to HTP, switching back to Cigarette-only, and exit to Non-current use.
FINDINGS: Weighted HTP prevalence increased from 0.1% to 14.9% during 2015-2025. Standardised prevalence rose sharply through 2018 (3.33 percentage points/year) and more gradually thereafter (0.92 percentage points/year). Transition probabilities showed post-2018 persistence of HTP-only/Dual use (67.9% and 57.0%, respectively). In the longitudinal decomposition, mean annual entry into HTP use increased from 2.16 percentage points before 2018 to 3.48 after 2018, while mean annual exit changed from -0.39 to -2.30. After 2018, entry from Non-current states increased markedly, whereas contributions from Never states were smaller and switching from Cigarette-only to HTP remained substantial.
INTERPRETATION: HTP use in Japan shifted around 2018 from rapid expansion to slower but sustained growth. Within the transition-eligible sample, later growth reflected multiple dynamics-including continued cigarette-to-HTP switching, persistence within HTP-using states, and increasing uptake from Non-current states-rather than cigarette substitution alone.
FUNDING: Japan Society for the Promotion of Science KAKENHI (25H01079).
METHODS: Using data from the Japan Society and New Tobacco Internet Survey, 2015-2025, we estimated weighted prevalence of HTP use (N = 161,583). Sex- and age-standardised prevalence was used to estimate segmented trends with a 2018 knot. Among respondents observed in consecutive years (93,540 pairs), we fitted a multinomial transition model across five states (Never, Non-current, Cigarette-only, HTP-only, and Dual use) and decomposed changes in standardised HTP prevalence into four categories: uptake from Never/Non-current states, switching from Cigarette-only to HTP, switching back to Cigarette-only, and exit to Non-current use.
FINDINGS: Weighted HTP prevalence increased from 0.1% to 14.9% during 2015-2025. Standardised prevalence rose sharply through 2018 (3.33 percentage points/year) and more gradually thereafter (0.92 percentage points/year). Transition probabilities showed post-2018 persistence of HTP-only/Dual use (67.9% and 57.0%, respectively). In the longitudinal decomposition, mean annual entry into HTP use increased from 2.16 percentage points before 2018 to 3.48 after 2018, while mean annual exit changed from -0.39 to -2.30. After 2018, entry from Non-current states increased markedly, whereas contributions from Never states were smaller and switching from Cigarette-only to HTP remained substantial.
INTERPRETATION: HTP use in Japan shifted around 2018 from rapid expansion to slower but sustained growth. Within the transition-eligible sample, later growth reflected multiple dynamics-including continued cigarette-to-HTP switching, persistence within HTP-using states, and increasing uptake from Non-current states-rather than cigarette substitution alone.
FUNDING: Japan Society for the Promotion of Science KAKENHI (25H01079).