Policy recommendation for the regulation of heated tobacco products based on evidence review of their health effects and influence on tobacco control

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  • NAKAMURA Masakazu
    Health Promotion Research Center, Japan Association for Development of Community Medicine
  • TABUCHI Takahiro
    Cancer Control Center, Osaka International Cancer Institute
  • OSAKI Yoneatsu
    Faculty of Medicine, Tottori University
  • YAMATO Hiroshi
    Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan
  • KUNUGITA Naoki
    School of health Sciences, University of Occupational and Environmental Health, Japan
  • YOSHIMI Itsuro
    Division of Tobacco Policy Research, Center for Cancer Control and Information Services, National Cancer Center
  • KATANODA Kota
    Division of Cancer Statistics Integration, Center for Cancer Control & Information Services, National Cancer Center
  • KAJI Masayuki
    Shizuoka City Public Health Center
  • AGEMATSU Ryuji
    Sensatsu Public Health Center, Kagoshima Prefecture

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Other Title
  • 加熱式たばこ製品の使用実態，健康影響，たばこ規制への影響とそれを踏まえた政策提言
  • カネツシキ タバコ セイヒン ノ シヨウ ジッタイ,ケンコウ エイキョウ,タバコ キセイ エ ノ エイキョウ ト ソレ オ フマエタ セイサク テイゲン

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<p>Objective This report aimed to present policy recommendations on the regulation of heated tobacco products based on a review of the literature on the use of heated tobacco products, component analysis of harmful chemical substances, and product characteristics as nicotine delivery device, and on an examination of the influence of the product's increasing usage to the main measures of tobacco control.</p><p>Methods The literature search was performed using Japan Centra Revuo Medicina and PubMED database. The search yielded 11 articles that examined the use of heated tobacco products, component analysis of harmful chemical substances, and product characteristics as nicotine delivery device. Eight articles were additionally collected from reports of public health research in Japan and public reports in foreign countries. The six main policies advocated by World Health Organization as MPOWER (Monitor, Protect, Offer, Warn, Enforce, Raise) were adopted in considering the expected influence of this product's increasing usage this product epidemic on tobacco control. In addition to the abovementioned 19 articles, 26 documents and materials related to the status of tobacco control were collected and used to examine the influence of the product's increasing usage to the main measures of tobacco control.</p><p>Results In Japan, heated tobacco products have been available since December 2013, and the spread of use has risen remarkably since 2016. As of October 2016, Japan consumed more than 90% of the heated tobacco products sold internationally. Compared with cigarettes, heated tobacco products can reduce exposure to harmful substances except nicotine. However, their use does not lead to reduced risk of illness. The reduction of exposure to harmful substances cannot be expected when used in combination with cigarettes. Heated tobacco products and cigarettes have similar nicotine exposure levels and pharmacokinetics; thus, use of the former results in nicotine dependence and exacerbates the difficulty in discontinuing tobacco consumption. The popularity of heated tobacco products could adversely affect any of the six main measures of tobacco control.</p><p>Conclusion Although public health concerns have been identified for the popularity of heated tobacco products, evidence remains insubstantial for the formulation of regulatory implications. Additional research is needed on the health effects to users and bystanders, effects on cigarettes use, and influence on tobacco control policy. From the perspective of the precautionary principle of public health, the same regulation as for cigarettes should be implemented as regards heated tobacco products until their health effects are fully elucidated.</p>

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