The Japanese Tobacco Miracle the World is Overlooking

Smokers in Japan consumed 92.4 billion cigarettes in 2023 -- less than half as many as they did in 2014.  Since vapor products are illegal there, the impressive decline is likely due to the introduction of heat-not-burn tobacco products, which didn’t exist in 2014, but accounted for 38% of the Japanese tobacco market in 2023.  Notably, this progress occurred in an overall declining tobacco market. 

UK tobacco harm reduction advocate Clive Bates previously opined: “The only mystery is why the skies over Tokyo are not dark with chartered planes bringing officials from WHO, FDA, Truth Initiative, the Campaign for Tobacco-Free Kids, the European Commission and others on an emergency mission to learn about this most extraordinary shift.  What is the secret they would find? ‘Do nothing, stay out of the way....’  There was very little involvement from tobacco control – the demise of cigarettes in Japan has been driven by the market and consumer preference.”

Those officials should also be landing in Stockholm, the capital of the only country that has had comparatively minuscule smoking rates among men and is close to being officially smoke-free.

Instead, the WHO and its nicotine/tobacco prohibitionist allies persist in meddling with the natural demise of smoking that will result from the proliferation of vastly safer and satisfying cigarette substitutes.

One positive development to note: The U.S. FDA authorized the IQOS heat-not-burn system as a reduced exposure alternative to cigarettes on July 7, 2020, greenlighting these claims:

“AVAILABLE EVIDENCE TO DATE:

• The IQOS system heats tobacco but does not burn it.
• This significantly reduces the production of harmful and potentially harmful chemicals.
• Scientific studies have shown that switching completely from conventional cigarettes to the IQOS system significantly reduces your body’s exposure to harmful or potentially harmful chemicals.”

The FDA advised that its approval “is expected to benefit the health of the population as a whole.”

Unfortunately, a patent dispute in 2021 blocked U.S. IQOS sales, but there is still hope for American smokers for re-introduction of the brand in 2024.

Back in 1995, I wrote (here), “It is not surprising to find that Swedish lung cancer mortality rates have been the lowest in Europe over the past 40 years.  These large scale vital statistics from Sweden…strongly support the suggestion that if tobacco is to be used, it should be in the form of [smokeless tobacco, ST] and not cigarettes. The population that uses ST in lieu of smoking is, in effect, protected from lung cancer and other major smoking-related diseases and suffers little or no increased risk of oral cancer.”  Seven years later I spent six months conducting research in Sweden and publishing a series of real-world tobacco harm reduction articles (here). 

The Japanese and Swedish miracles weren’t the result of government programs or anti-tobacco campaigns.  They arose organically, as tobacco users in those countries made rational choices to use smoke-free substitutes instead of cigarettes.

 

 

Sharp Decline in High School Vaping as Smoking Is Almost Eliminated

 

Last week, five and a half months after the CDC and FDA published selective information on 2021 teen vaping (generating frightening “epidemic” headlines in major news media), the CDC finally released data from the 2021 National Youth Tobacco Survey (NYTS).  I have confirmed the CDC finding that “11.3% of high school students (1.72 million) … reported current (past 30 day) e-cigarette use” (here).  However, the CDC failed to mention that this is a 58% reduction in high school vaping from peak prevalence of 27.5% (or 4.1 million) in 2019.  The survey also indicates that high school cigarette smoking declined to 1.9%.  

 

As indicated in the chart, this represents a profound alteration from 2018, when the vaping rate among high schoolers increased substantially.  The vaping rate rose again in 2019, but plummeted the next two years.  Importantly, during that period the smoking rate fell 77%, from 8.3% to 1.9%.  Tobacco prohibitionists’ claim that vaping would prove a gateway to smoking was without merit.  In fact, it is now clear that vaping helped cancel smoking.

Let’s explore some gaps in the government’s representation of the 1.72 million high school vapers.  First, about 519,000 of those vapers had also used other tobacco products, including cigarettes, cigars, pipes, hookah, smokeless tobacco, nicotine pouches and/or heat-not-burn (HNB) products.  With respect to HNB, the NYTS has some odd data points.  Roughly 316,000 high schoolers reported that they had ever used HNB, and 123,000 said they were current users.  That is simply impossible.  The only HNB sold in the United States was IQOS, but that product was taken off the market by a patent lawsuit.  Additionally, Philip Morris International implemented strict controls that limited teens’ ability to obtain the products.      

Of the 1.2 million “virgin” vapers with no other tobacco use, 732,000 used the products infrequently (19 days or fewer in the past month), and 467,000 vaped 20+ days.  This means that up to 3% of American high school students with no other tobacco use could have become addicted to vaping nicotine, a drug that is not associated with any smoking-related disease.  That number, while of concern, does not constitute an “epidemic,” even though anti-tobacco activists constantly use that term (here).

As I have noted previously, high school vapers are not just using tobacco/nicotine; they are  vaping marijuana at high rates as well. The next chart shows a large majority of high school vapers, regardless of frequency, have vaped marijuana. 

 

   

Government public health officials express moral outrage about youth nicotine use, but their concern ought to be directed at the real high school epidemics, evidenced by these statistics from the CDC:

39% text/email while driving

30% drink alcohol

20% use marijuana

17% ride with a driver who had been drinking

17% considered suicide in the past year

16% carry a weapon

14% binge drink

13% drive after marijuana use

Note to activists: Prioritize the activities putting teens at actual risk of injury and death.

 

 

2020 National Youth Tobacco Survey Introduced U.S. Youth to Heat-Not-Burn Tobacco Brands

 

Anti-tobacco crusaders continue to promote e-cigarettes and vape products to the nation’s youth.

ABC News has published a screed by University of Chicago pediatric resident physician Chidimma Acholonu in which she claims that “now a new smoke-free alternative called heated tobacco  is slowly gaining a foothold in the U.S. market…While heated tobacco products [known as heat-not-burn, HNB] only became legal in the United States in 2019, the device have [sic] already started to catch the attention of high school students.”

Dr. Acholonu credits unnamed “experts” for news that “Tobacco companies are attempting to glamorize these products.” How? Erika Sward, assistant vice president for advocacy at the American Lung Association, says, “[Tobacco companies are] attempting to make the packaging and the marketing look white and clear and clean and very modern.”

Huh? A teen HNB epidemic is going to be driven by white, clear, clean and modern packaging?

Dr. Acholonu is wrong when she says that HNBs “only became legal in the United States in 2019.” Reynolds’ Eclipse has been on and off the U.S. market for about 20 years, although it has never proven to be a viable substitute for combusted cigarettes.

Dr. Acholonu was probably referring to IQOS. The FDA authorized IQOS sales in 2019, and the agency approved a reduced exposure claim in 2020, saying its decision “is expected to benefit the health of the population as a whole.” IQOS has driven an unprecedented decline in cigarette consumption in Japan, and it is now available in more than 60 countries.

To analyze Dr. Acholonu’s claim that HNBs are catching the attention of high schoolers, let’s take a close look at the 2020 National Youth Tobacco Survey, which described HNB products this way:

“Some people refer to these products as ‘heat-not-burn’ tobacco products. Heated tobacco products heat tobacco sticks or capsules to produce a vapor. They are different from e-cigarettes, which heat a liquid to produce a vapor. Some brands of heated tobacco products include iQOS, glo, and Eclipse.”

Only 202 of the 14,531 students surveyed had used HNBs during the past 30 days, which represents about 1.4% of all U.S. middle and high school students. But there’s more.

The NYTS survey asked participants “Before today, have you heard of heated tobacco products?”  The survey provided a handy description, saying that HNBs “are different from e-cigarettes, which heat a liquid to produce a vapor.”  Just in case the kids were still unsure, the survey taught them some brands to look for: “Some brands of heated tobacco products include iQOS, glo, and Eclipse.” 

Over 11,600 (80%) of middle and high school students had not heard of HNBs. For these youths, the NYTS was their first introduction to iQOS, glo and Eclipse.

Let’s get back to the 202 HNB current users: 61 of them had never heard of HNBs “before today.” If they never heard of them, they didn’t use them, so they shouldn’t be counted. 

Now we have 141 HNB users, 67 of whom said they had used one or more of the following HNB flavors: clove, spice, chocolate, wine, cognac, cocktail flavors, candy, dessert, or sweets.  This is impossible, as IQOS and Eclipse are not sold in any of these flavors. Those 67 should not be counted.

Now we have 74 kids who said they are HNB users, which works out to be 0.4% of middle school students and 0.7% of high schoolers. With only limited availability of HNB products, it is likely that many of those respondents were mistaken, answering “yes” to the HNB question when they meant e-cigarettes or vapor products. In fact, among current HNB users, 60% were current e-cigarette users; only 14% were not using any other tobacco product.

In summary, the 2020 NYTS introduced large numbers of middle and high school students to HNB products for the first time. No amount of misinformation, like the ABC News story, can alter the facts about the phony “next teen tobacco epidemic.”