Update of Current Status in Japan on Tobacco Harm Reduction GNF 2019 HIROYA KUMAMARU, MD, PHD AOI UNIVERSAL HOSPITAL GLOBAL NICOTINE FORUM 2019 Number of deaths due to smoking in JAPAN 2 （ ） x1000 121 120 117 121+36=151,000/ in 2015 108 Male 128,000/ in 2007 Female 100 100 85 80 71 No. No. of death 59 60 47 37 36 40 31 32 32 26 23 27 18 20 13 8.0 4.1 0 '50 '55 '60 '65 '70 '75 '80 '85 '90 '95 '00 '05 ‘10 (year） Peto, R. et al.：MORTALITY FROM SMOKING IN DEVELOPED COUNTRIES 1950−2020 JAPAN CTSU：265, 2015 より作図 http://gas.ctsu.ox.ac.uk/tobacco/C3160.pdf Economical loss : ￥4.3 trillion due to smoking in Japan Economic Loss due to Smoking Loss of labor force due to smoking related diseases 23,596 billion yen Positive Economic Impact Cleaning expense due to smoking 39 billion yen Fire safety expense due to smoking 1,879 billion yen Medical expenditure of bystanders affected by passive smoking 1,431 billion yen Medical expenditure of smokers 16,249 billion yen 2.8 trillion yen 4.3 trillion yen Source: Health Economics Research Group, 2005 statistics Heat-not-burn products IQOS：Phillip Morris International Glo : British American Tobacco Ploom-Tech : Japan Tobacco were launched since 2014 in Japan Overall tobacco consumptions keeps decreasing, while cigarettes are replaced quickly by smoke-free products (Japan) 21% reduction (15% year before) Source: Tobacco Institute of Japan IMS and PMJ Estimate/smokefree products ＋ includes competitive smoke-free products IMS Youth Initiation of HNB - MOH Grant Research • Prof. Y Osaki of Tottori Unversity, Medical School • A study of drinking behavior, smoking behavior, sleep disruption, and excessive internet use • Among approximately 64,000 Japanese middle and high school students • Surveys were conducted in schools between December 2017 and February 2018. Within smoking behavior, the authors looked at patterns of cigarette smoking, heated tobacco product use, and e-cigarette use. Specifically, they asked participants to report ever, monthly, and daily use of these products. Results are summarized in the table below: Source: Yoneatsu Osaki, Chief investigator, Professor, Division of Environmental and Preventive Medicine, Faculty of Medicine, Tottori University. https://mhlw-grants.niph.go.jp/niph/search/NIDD00.do?resrchNum=201709021A 6 New versions of IQOS IQOS 3 \10,980(4,980) IQOS 3 Multi \8,980 New versions of glo glo series 2 \2,980 glo series 2 mini \3,980 New Color Variation & Version of Ploom-TECH Ploom-TECH \2,980 Ploom-TECH+ \4,980 Latest version & color variation of Ploom S Ploom S \7,980 JT has changed strategy to use tobacco leaves not like former versions Smoking Restrictions in Japan (2017-18) National Level Outdoor No national restrictions Indoor Health Promotion Law Facility manager efforts to prevent passive smoking in public places Industrial Safety and Health Law Employers efforts to prevent passive smoking in the workplace Local Level Outdoor Outdoor smoking restrictions in around 220/800 municipalities Of these, approx. half have exempted HNB from restrictions Indoor Two Prefectures (Hyogo / Kanagawa) have indoor smoking restrictions Tokyo Metropolitan Government passed an ordinance to prevent passive smoking to be implemented by 2020. e-cigarettes expectation and launch Summary 3 HnB products have been still successful to reduce cigarette smoking in Japan so far. HnBs are not causing “Gateway phenomenon” in younger generation in Japan. Movement of smoke-free environment is on-going by the Japanese government towards Tokyo Olympic in 2020. From the viewpoint of physician, Vapor products are even more favorable than HnBs for nicotine-dependent people and are expected to be launched shortly (I hope ASAP). Pharmacological efficacy of nicotine for dementia/MCI, other neuro- psychological impairment is very interesting. Thank you for your attention !! Health and Labour Sciences Research Grant (Comprehensive research project on cardiovascular diseases, diabetes mellitus, and other lifestyle-related diseases) Annual Report of MHLW Research Committee Field survey on drinking and smoking and the development of effective alcohol reduction intervention approaches for the prevention of lifestyle-related diseases Yoneatsu Osaki Chief investigator Professor, Division of Environmental and Preventive Medicine, Faculty of Medicine, Tottori University Project summary The investigators conducted a nationwide survey in 2017 to find out about the alcohol drinking and smoking behaviors of middle- and high-school students in Japan. Frequency of drinking and that of smoking among the youth of middle- and high-school age were lower than the results of our previous survey. The frequency of drinking per week and the frequency of smoking per month and per day were extremely low. Other prominent findings included the following: certain percentages of drinkers were heavy drinkers and binge drinkers (i.e. drinkers consuming large quantities of alcohol in a single session); many of the drinkers and smokers were able to purchase alcohol and cigarettes by themselves; the use of non-alcoholic “beers” and cocktail drinks was on the rise; middle- and high-school students were victims of “alcohol harassment (i.e. the act of forcing others to drink as an abuse of authority)”; the frequency of using cigarette alternatives was nearly as high as that of conventional cigarettes; higher prices, age verification, and restrictions on the use of vending machines appeared to make it difficult to obtain cigarettes; their exposure to secondhand smoke was still high and the frequency of passive smoking outside home showed no decrease; the frequency of sleeping disturbance remained high; and excessive Internet use was on the rise. A review of literature on the health effect of alcohol use was conducted, and a substantial number of articles with high levels of evidence were collected. Data on evidence-based brief intervention were collected to be used for an alcohol reduction program scheduled to be launched in FY 2018, and these data have been used as basic data for the development of intervention programs that reflect the reality in Japan. 1 know-how on the method. The nationwide study Project investigators conducted in FY 2017 shed light on the smoking and drinking behaviors of Japan's middle- and Yoshitaka Kaneita (Professor, Nihon University high-school students, and this has made it possible School of Medicine) to evaluate our progress towards the targets and Hideyuki Kanda (Professor, Shimane University identify what our challenges are at this point. In Faculty of Medicine) the meantime, there are also targets for adult Susumu Higuchi (President, National Hospital drinking (i.e. percentage of adults who consume Organization Kurihama Medical and Addiction) alcohol at a level that increases a risk of Osamu Itani (Associate Professor, Nihon developing lifestyle-related diseases). Again, University School of Medicine) evaluation of the progress toward these targets is Hisashi Yoshimoto (Associate Professor, possible only based on the type of survey that is University of Tsukuba Faculty of Medicine) similar to the nationwide survey our group Hitoshi Maesato (Director, National Hospital conducted on adult drinking behaviors, in 2003, Organization Kurihama Medical and Addiction) 2008, and 2013 (Osaki Y, 2016). The 2018 Aya Kinjo (Lecturer, Tottori University Faculty nationwide survey has helped us understand the of Medicine) drinking behaviors of adults, evaluate the measures Maki Jike (Assistant Professor, Nihon that have been taken so far, and identify the University School of Medicine) challenges we have. Yuichiro Otsuka (Assistant Professor, Nihon As a result of the development of master plan University School of Medicine) under the Basic Act on Measures against Ruriko Minobe (Physician, National Hospital Alcohol-related Health Harm, it is now required Organization Kurihama Medical and Addiction) that screening be performed to identify problem Yuki Kuwabara (Assisstant Professor, Tottori drinkers, and support to reduce drinking (brief University Faculty of Medicine) intervention) be provided. Under the Specific Health Guidance, brief intervention (BI) is to be A. Objectives provided based on the Alcohol Use Disorders Healthy Japan 21 (2nd term) aims for zero Identification Test (AUDIT) since FY 2013. underage smoking and drinking. Evaluating the Whether or not it is actually provided in real life results of the efforts requires that the levels be settings is not clear, however, and our group aims monitored using the same method used in the study to find out how AUDIT is performed, followed by that produced the baseline levels for the evaluation. BI, in the Specific Health Checkups and Specific Our group has conducted a nationwide survey in Health Guidance settings, and look into any 1996, 2000, 2004, 2007, 2008, 2010, 2012 and obstacles in performing the test and providing the 2014 (Osaki Y, 2008, 2009), and has accumulated intervention. In the West, multiple randomized 2 controlled studies have demonstrated BI's effects review; and (3) to gather evidence on brief in helping people cut down on alcohol interventions in Japan and overseas that aim to consumption in the primary care settings reduce excessive alcohol consumption, and (Cochrane Database, 2007). In Japan, meanwhile, develop brief intervention programs that reflect the evidence of the effects of BI has yet to be reality in Japan. established even as the policy has already been launched, which raises an issue. In this project, our B. Research approaches