Use of heated tobacco products by people with chronic diseases: The 2019 JASTIS study

PLoS One. 2021 Nov 18;16(11):e0260154. doi: 10.1371/journal.pone.0260154. eCollection 2021.


Heated tobacco products (HTPs) have become popular recently. People with chronic disease, such as diabetes, cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD) and cancer, should quit smoking for treatment and recurrence of tobacco-related diseases. However, they have difficulty in quitting smoking, and they may start HTPs use to quit smoking. The purpose of this study is to examine the use of HTPs in people with chronic disease. We used data from an internet study, the Japan Society and New Tobacco Internet Survey (JASTIS). We analyzed 9,008 respondents aged 15-73 years in 2019 using logistic regression. Current use of tobacco products was defined as use within the previous 30 days. Prevalence of current HTP use including dual use and dual use with cigarettes was 9.0% and 6.1% respectively in total. By disease: hypertension 10.2% and 7.4%, diabetes 15.9% and 12.3%, CVD 19.2% and 15.7%, COPD 40.5% and 33.3%, and cancer 17.5% and 11.9%. Diabetes, CVD, COPD, and cancer were positively associated with current use of HTPs (odds ratios (ORs) and 95% confidence intervals (CIs): 1.48 (1.06, 2.07), 2.29 (1.38, 3.80), 3.97(1.73, 9.11), and 3.58(1.99, 6.44), respectively) and dual use of cigarettes and HTPs (ORs and 95% CIs: 2.23 (1.61, 3.09), 3.58 (2.29, 5.60), 7.46 (3.76, 14.80), and 2.57 (1.46, 4.55), respectively) after adjusting for confounders. People with chronic disease were more likely to use HTPs and HTPs together with cigarettes. Further research on the smoking situation of HTPs in patients with chronic diseases is necessary.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cardiovascular Diseases
  • Chronic Disease / psychology
  • Female
  • Humans
  • Hypertension
  • Internet
  • Japan / epidemiology
  • Male
  • Medical History Taking
  • Middle Aged
  • Pulmonary Disease, Chronic Obstructive
  • Smoking
  • Surveys and Questionnaires
  • Tobacco
  • Tobacco Products / adverse effects*
  • Tobacco Smoking / trends*
  • Tobacco Use / trends*
  • Vaping / trends

Grants and funding

The study is supported by Health Labor Sciences Research Grants (20FA1005; 19FA0501; 19FA2001; and 19FA1011, and the Japan Society for the Promotion of Science (JSPS) KAKENHI Grants (18H03062, for TT. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.