Abstract
Background Globally, among a wide range of public health concerns, smoking remains one of the most crucial challenges. Especially for adolescents, the increase in the use of electronic cigarettes is controversial, as its use may lead to established smoking. In Japan, where a unique tobacco regulation system exists, the heat-not-burn tobacco market has been growing. However, the prevalence and association of combustible cigarettes and new tobacco-related products have not yet been closely investigated among Japanese adolescents. This study aimed to clarify the prevalence of smoking among adolescents including new types of tobacco-related products and to compare the characteristics of their users.Methods In 2017, a cross-sectional survey was conducted with randomly sampled junior high school and high school students from 47 prefectures nationwide. Overall, 98 junior high schools in 44 prefectures and 86 high schools in 42 prefectures were included in the survey. In total, 22,275 students from 48 junior high schools and 42,142 students from 55 high schools completed an anonymous questionnaire while at school.Results The age-adjusted rate of ever (current) use of electronic cigarettes was 2.1% (0.7%) in junior high school and 3.5% (1.0%) in high school; that of combustible cigarettes was 2.6% (0.6%) in junior high school and 5.1% (1.5%) in high school; the rate of heat-not-burn tobacco use was lower relative to the other products: 1.1% (0.5%) in junior high school and 2.2% (0.9%) in high school. Examination of the combined use of the three types of products identified a high number of dual users. Comparison between different types of users indicated different backgrounds of combustible cigarette users and new products users.Conclusions The prevalence of new tobacco-alternative products is growing in popularity among Japanese adolescents. Dual use is common, and many adolescents use new products only. Moreover, e-cigarettes might lure a broader range of groups to smoking. Continuous monitoring and further research should investigate the health impact of new products to promote public health action regarding smoking epidemics.