Between 2011 and 2015, cigarette sales in Japan were declining at a slow but steady pace. However, the pace of decline in cigarette sales accelerated beginning in 2016, corresponding to the introduction of HTPs into the marketplace. This finding is consistent with the conclusion of Stoklosa and colleagues  who examined data on sales of tobacco products from participating supermarkets and convenience stores in different regions of Japan between 2014 and 2018. The accelerated decline in cigarette sales in Japan after 2016 is rather remarkable since it appears to have happened independent of efforts made by public health groups that have largely opposed the marketing of HTPs . Also, Japan does not have strong smoking control measures in place and prohibits the marketing of electronic nicotine delivery systems (ENDS), which have been associated with declining cigarette sales in the United States and England [10,11,12].
This study does not address the extent to which individual cigarette smokers are substituting HTPs for conventional cigarettes. A recent study suggests that most HTP users in Japan are also concurrently smoking cigarettes . That said, these data do suggest that in Japan at least, the decline in cigarette sales has been accelerated by the introduction of HTPs. It is hard to know if the findings in Japan can be replicated globally, but reported sales trends in other markets where HTPs have been introduced show a similar inverse association between cigarette and HTP sales . Given the hype associated with HTPs, manufacturers need to do more to share their marketing data with public health officials and investors so that individual-level cigarette substitution and harm reduction from smoking can be accessed. Given the history of the cigarette industry, public health groups have a right to be skeptical of any industry product claims, however assuming all tobacco/nicotine products as equivalently harmful is also counterproductive to public health goals as it only serves to protect the most lethal nicotine product—cigarettes. The evolving marketplace of potentially lower-risk nicotine products of which HTPs are just one category, combined with regulatory authority over tobacco products, represents a new opportunity to dramatically transform the cigarette business in ways that were never imagined when the war on tobacco was raging decades ago. However, this requires embracing risk-proportionate regulatory and taxation policies and providing consumers with accurate public messaging on product relative risks . One can only imagine what might be accomplished if market forces were aligned with public health goals to reduce premature deaths caused by smoking.
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