Nakamura Masakazu, Tabuchi Takahiro, Osaki Yoneatsu, Yamato Hiroshi, Kunugita Naoki, Yoshimi Itsuro, Katanoda Kota, Kaji Masayuki, Agematsu Ryuji
Health Promotion Research Center, Japan Association for Development of Community Medicine.
Cancer Control Center, Osaka International Cancer Institute.
Nihon Koshu Eisei Zasshi. 2020;67(1):3-14. doi: 10.11236/jph.67.1_3.
Objective This report aimed to present policy recommendations on the regulation of heated tobacco products based on a review of the literature on the use of heated tobacco products, component analysis of harmful chemical substances, and product characteristics as nicotine delivery device, and on an examination of the influence of the product's increasing usage to the main measures of tobacco control.Methods The literature search was performed using Japan Centra Revuo Medicina and PubMED database. The search yielded 11 articles that examined the use of heated tobacco products, component analysis of harmful chemical substances, and product characteristics as nicotine delivery device. Eight articles were additionally collected from reports of public health research in Japan and public reports in foreign countries. The six main policies advocated by World Health Organization as MPOWER (Monitor, Protect, Offer, Warn, Enforce, Raise) were adopted in considering the expected influence of this product's increasing usage this product epidemic on tobacco control. In addition to the abovementioned 19 articles, 26 documents and materials related to the status of tobacco control were collected and used to examine the influence of the product's increasing usage to the main measures of tobacco control.Results In Japan, heated tobacco products have been available since December 2013, and the spread of use has risen remarkably since 2016. As of October 2016, Japan consumed more than 90% of the heated tobacco products sold internationally. Compared with cigarettes, heated tobacco products can reduce exposure to harmful substances except nicotine. However, their use does not lead to reduced risk of illness. The reduction of exposure to harmful substances cannot be expected when used in combination with cigarettes. Heated tobacco products and cigarettes have similar nicotine exposure levels and pharmacokinetics; thus, use of the former results in nicotine dependence and exacerbates the difficulty in discontinuing tobacco consumption. The popularity of heated tobacco products could adversely affect any of the six main measures of tobacco control.Conclusion Although public health concerns have been identified for the popularity of heated tobacco products, evidence remains insubstantial for the formulation of regulatory implications. Additional research is needed on the health effects to users and bystanders, effects on cigarettes use, and influence on tobacco control policy. From the perspective of the precautionary principle of public health, the same regulation as for cigarettes should be implemented as regards heated tobacco products until their health effects are fully elucidated.
本报告旨在基于对加热烟草制品使用的文献综述、有害化学物质的成分分析、作为尼古丁输送装置的产品特性，以及对该产品使用增加对烟草控制主要措施的影响的考察，提出关于加热烟草制品监管的政策建议。
使用日本医学中央杂志和PubMed数据库进行文献检索。检索得到11篇考察加热烟草制品使用、有害化学物质成分分析以及作为尼古丁输送装置的产品特性的文章。另外从日本公共卫生研究报告和国外公共报告中收集了8篇文章。在考虑该产品使用增加（即该产品流行）对烟草控制的预期影响时，采用了世界卫生组织倡导的MPOWER（监测、保护、提供、警示、执行、提高）六项主要政策。除上述19篇文章外，还收集了26份与烟草控制状况相关的文件和资料，用于考察该产品使用增加对烟草控制主要措施的影响。
在日本，加热烟草制品自2013年12月起上市，自2016年以来使用的传播显著增加。截至2016年10月，日本消费额占国际销售的加热烟草制品的90%以上。与卷烟相比，加热烟草制品除尼古丁外可减少有害物质暴露。然而，其使用并不会降低患病风险。与卷烟同时使用时，无法预期有害物质暴露会减少。加热烟草制品和卷烟具有相似的尼古丁暴露水平和药代动力学；因此，使用前者会导致尼古丁依赖，并加剧戒烟的难度。加热烟草制品的流行可能对烟草控制的六项主要措施中的任何一项产生不利影响。
尽管已确定加热烟草制品的流行引发了公共卫生问题，但制定监管措施的证据仍然不足。需要对使用者和旁观者的健康影响、对卷烟使用的影响以及对烟草控制政策的影响进行更多研究。从公共卫生预防原则的角度来看，在加热烟草制品的健康影响得到充分阐明之前，应实施与卷烟相同的监管措施。
