[Trends in smoking status and quit attempts among cigarette smokers]

Objectives　The purpose of this study was to clarify smoking status and quit attempts among cigarette smokers after the release of heated tobacco products.Methods　We used data from the 2016, 2018, 2020, and 2022 waves of the Japan "Society and New Tobacco" Internet Survey (JASTIS), which aims to facilitate a better understanding of the current situation regarding new tobacco products in Japan. Participants were aged between 20 and 69 years in each wave and were regular cigarette smokers. Survey items included basic characteristics, smoking status, types of tobacco products smoked in the past year, and quit attempts and methods. We calculated the frequencies of basic characteristics, smoking status, and quit attempts for each survey year. Frequencies of quit attempt methods and overlapping status were also calculated. Chi-square tests were applied to each item, and significant differences were compared with the results from the previous year. The Cochran-Armitage trend test was applied to smoking status and quitting attempts.Results　There were 934 participants in 2016, 1,717 in 2018, 1,348 in 2020, and 4,117 in 2022. Most participants were in their 40s and 50s, and approximately 70% were male. The rate of cigarette-only smokers was 94.5% in 2016, dropping sharply to 60.3% in 2018 (P < 0.001). Conversely, the number of smokers who used cigarettes in combination with either heated tobacco products or e-cigarettes increased sharply from 4.0% to 37.3% within the same period (P < 0.001). The quit attempt rate was 16.0% in 2016, increasing annually and reaching 40.1% by 2022 (P < 0.001). The most common quit attempt method in 2016 was self-help, accounting for 71.8%, decreasing to 41.7% in 2018 (P < 0.001), while the use of heated tobacco products/e-cigarettes increased during the same period from 28.9% to 64.3% (P < 0.001). In 2016, smoking cessation treatments and nicotine preparations from pharmacies accounted for 18.1% and 26.2%, respectively, with both increasing since 2020.Conclusion　Since the launch of heated tobacco products, the number of smokers using cigarettes has decreased, whereas the number of smokers using heated tobacco products and/or e-cigarettes in combination with cigarettes has increased. Simultaneously, the rate of quit attempts has been steadily increasing, with growing preference for heated tobacco products/e-cigarettes as cessation methods. Emerging evidence indicates that heated tobacco products pose health risks and may also lower the success rate of quitting smoking, while increasing the relapse rate, making them an unsuitable cessation option.