Exposure to Secondhand Heated-Tobacco-Product Aerosol May Cause Similar Incidence of Asthma Attack and Chest Pain to Secondhand Cigarette Exposure: The JASTIS 2019 Study

Int J Environ Res Public Health. 2021 Feb 11;18(4):1766. doi: 10.3390/ijerph18041766.


Although secondhand cigarette smoke is known to cause various health consequences, even the short-term effects of exposure to secondhand heated-tobacco-product (HTP) aerosol are unknown. The purpose of this study was to examine short-term symptoms related to secondhand HTP aerosol exposure. An internet-based self-reported questionnaire survey was conducted in 2019 as a part of the Japan Society and New Tobacco Internet Survey (JASTIS) study. In total, 8784 eligible respondents aged 15-73 years were analyzed. We examined the frequency (%) of secondhand combustible cigarette smoke and HTP aerosol exposure, and the exposure-related subjective symptoms (sore throat, cough, asthma attack, chest pain, eye pain, nausea, headache, and other symptoms). Overall, 56.8% of those exposed to secondhand cigarette smoke had any subjective symptoms, compared to 39.5% of those exposed to HTP aerosol. Asthma attack and chest pain were reported more frequently when associated with secondhand HTP exposure (10.9 and 11.8%, respectively) than with secondhand cigarette smoke exposure (8.4 and 9.9%, respectively). Sore throat, cough, eye pain, nausea, and headache were also more frequently reported when associated with secondhand cigarette smoke than with secondhand HTP exposure. This is the first study to examine severe subjective symptoms such as asthma attacks and chest pains, and to suggest that respiratory and cardiovascular abnormalities could be related to secondhand heated-tobacco-product aerosol exposure. Further careful investigations are necessary.

Keywords: asthma attack; chest pain; heated tobacco product; secondhand smoke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aerosols / analysis
  • Aged
  • Asthma*
  • Chest Pain
  • Humans
  • Incidence
  • Internet
  • Japan / epidemiology
  • Middle Aged
  • Surveys and Questionnaires
  • Tobacco
  • Tobacco Products*
  • Tobacco Smoke Pollution* / adverse effects
  • Young Adult


  • Aerosols
  • Tobacco Smoke Pollution