The ‘bunen’ system in Japan is a system of separation for smoking and non-smoking areas. — Photo by Alva Pratt/Unsplash
THE latest findings of Global Adult Tobacco Survey (GATS) 2023 that was released a month ago revealed that the smoking prevalence has increased from 0.8% in 2011 to 5.8% in 2023.
GATS 2023 was published by the Public Health Institute, from the Health Ministry, in collaboration with the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC).
Among smokers aged 15 to 24, the prevalence of e-cigarette users reached 8.6% in 2023, compared to 1.1% in 2011.
Furthermore, the survey also reports an increase in the prevalence of dual users of tobacco and e-cigarettes from 0.8% in 2011 to 3.9%.
Aligning with the WHO Framework Convention on Tobacco Control (FCTC), the Health Ministry has passed the Smoking Products Control Act for Public Health 2024 (Act 852) since Feb 2 of this year and started enforcing as of June to help in curbing the youth uptake of vape products.
Against the backdrop of the concerning GATS 2023 findings and the Health Ministry’s proactive approach, it becomes imperative to delve into how Japan addresses the issue of alternatives to traditional smoking.
How Japan handles alternatives
In 2018, the Tokyo Metropolitan Assembly implemented a stricter anti-smoking ordinance compared to the national regulations in Japan.
The aim was to reduce second-hand smoke and create a tobacco-free environment for the then 2020 Olympics.
The smoking ban in Tokyo preceded a similar amendment to the Health Promotion Law that was under discussion in the national Diet.
The Tokyo ordinance will cover approximately 84% of restaurants and bars in the city, while the revised national law is expected to regulate around 45% of such establishments.
Despite being stricter than the national legislation, the ordinance falls short of a complete ban on smoking.
Certain institutions like universities, hospitals and government offices will have less stringent regulations, permitting smoking in designated outdoor areas.Meanwhile, gyms, hotels and some eateries will face more relaxed restrictions, as smoking is only prohibited indoors, while designated rooms equipped to prevent smoke from spreading are available for smoking.
Addressing the issue of second-hand smoke was also a pressing matter for Japan, which, despite being a member of the WHO tobacco control convention, lacks a nationwide law prohibiting smoking in public spaces.
In fact, according to a WHO report from 2017, Japan ranked in the lowest-tier group regarding smoke-free policies.
According to local Japanese reports from 2017, similar to the Health Promotion Law amendment, the new ordinance does not impose any penalties for the use of heat-not-burn products, as there is currently no scientific evidence confirming the adverse health effects of their second-hand smoke.
As a result, customers will be allowed to use e-cigarettes while dining in designated smoking areas within restaurants and bars, called the “bunen” system.
A scientific case study
The case study of Japan shows the effectiveness of adopting smoke-free products in reducing smoking prevalence.
Based on data collected by the Japanese National Health and Nutrition Survey (NHNS) in 2019, the smoking prevalence among Japanese adults is approximately 16.7%.
Further dissection showed that 27.1% of men and 7.6% of women consume tobacco products at least once a month.
According to the same NHNS, there has been a significant decrease in the prevalence of adult cigarette smoking after the introduction of heated tobacco products (HTPs).
In 2014, before the introduction of these products, 20% of adults reported smoking either daily or occasionally.
By 2019, the smoking prevalence had dropped to 13%.
The survey further revealed that a large majority of heated tobacco users, specifically 76% in 2019, did not report any cigarette smoking.
Tobacco heated systems (THS) was first introduced in Nagoya, Japan, late 2014 as a city-pilot and launched nationwide in 2016.
In a literature review by PMI Science, following the HTP’s introduction from beginning from 2015, “cigarette sales began to substantially decline in each of the Japanese regions.
“Before this nationwide launch, total tobacco sales in Japan declined at a rate of 1.8% on average between 2011 and 2015.”
The study also found that after the launch of the HTPs in Japan, the total tobacco sales continued to follow that same trend.
Most notably, the sale of cigarettes fell more sharply after the nationwide launch of HTPs such as IQOS: a 9.5% average annual decline from 2015 to 2018.
Achieving tangible results
Regulation in Japan draws a distinction between HTPs and combustible cigarettes.
HTPs heat tobacco just enough to release a nicotine-containing aerosol without burning the tobacco.
As the tobacco is heated and not burned, there is no smoke, and the levels of harmful and potentially harmful chemicals in the generated aerosols can be significantly reduced compared to combustible cigarette smoke.
In an air quality assessment study published in MDPI, researchers found that the levels of nicotine and other chemicals measured during use were very low and below the established limits for safety, showing that the air quality indoors remained within acceptable levels.
Compared to cigarettes and other products that produce smoke through burning, heated tobacco had a much smaller impact on the air quality indoors, with significantly lower levels of harmful substances.
PMI East Asia and Australia communications director Jeremy Custance commented, “Legislators and the public need accurate information about the products.
“They need to understand that there is a fundamental difference [between HTPs] and cigarettes.
“One of the reasons Japan adopted these HTPs is due to hygiene – there is no ash, smell or smoke, making it a better option for the people around you as well compared to smoking a cigarette,” he added.
He continued explaining that HTPs’ grew in popularity among Japanese consumers because the nation, as a whole, is conscientious about manners and considerate of others.
“IQOS aerosol, on average, has 95% less harmful constituents than a cigarette.
“This is a big difference and impact for individuals who choose to continue smoking,” Custance said.
He added that PMI is pushing the industry towards smoke-free products in an attempt to phase out combustibles.
“When IQOS was introduced, we saw an accelerated drop, about five times faster than before, of cigarette sales in Japan.”
According to the most recent report by the Tobacco Institute of Japan, the introduction of HTPs resulted in a remarkable 44% decrease in cigarette consumption within a short span of five years.
This decline represents the most substantial reduction in cigarette consumption ever observed in Japan.
“Regulation for tobacco products should be on a continuum of risk. For instance, the ‘most harmful’ product in this case, a combustible cigarette, whereas products that don’t burn, like HTPs, dramatically reduce harmful chemicals – so it doesn’t make sense that they are regulated the same way as they are scientifically, fundamentally different,” Custance emphasised.
