Philip Morris International (PMI) previously explored innovative transformation and how our smoke-free mission is leading the industry away from cigarettes. Building on this discussion, we now delve into the crucial role smoke-free products have in the concept known as “tobacco harm reduction” (THR)—a pragmatic approach to reducing the levels of smoking-related harms by moving adults who don’t quit smoking away from cigarettes to better, smoke-free alternatives. Real-life examples demonstrate the significant strides smoke-free products have made in public health and how this could translate to benefit the four million Texans who continue to smoke.

Tobacco Harm Reduction

For current smokers, the best step they can take is to quit tobacco use altogether. But despite the known health risks, many smokers don’t quit.

While no tobacco product is safe, the FDA states that scientific evidence “indicates that tobacco products exist on a continuum of risk, with cigarettes being the most harmful.” Therefore, consuming nicotine without burning tobacco—which produces smoke that directly contributes to smoking-related diseases—provides existing adult smokers with better alternatives to cigarettes.

The harm reduction equation provides an intuitive way to think about how better choices, and an increased rate of adoption of those better choices by existing smokers, can benefit public health. For any smoke-free alternative to be successful in reducing harm compared with continued smoking, it has to fulfill two criteria: it must be scientifically substantiated as significantly less harmful than continuing to smoke cigarettes; and it should be satisfying for current adult smokers so that they completely switch.

Today, there are a growing number of new, smoke-free alternatives to cigarettes on store shelves, and more innovations on the way—like e-cigarettes, oral nicotine pouches and heated tobacco products—which can help move American adults who smoke away from cigarettes for good.

A History of Smoking in Japan

Excessively high smoking rates used to be one of Japan's major public health concerns. In the 1960s, 80 percent of Japanese men smoked cigarettes. By 2000, nearly 50 percent of all men in Japan, and 33 percent of all adults, smoked cigarettes.

Smoking-related diseases were prevalent and public health bodies called for a solution that could address issues related to smoking in Japan and around the world. Yet, the country’s decline in cigarette sales at the start of the twenty-first century was around two percent annually—a much slower pace than in comparable countries—and slowed even more between 2011-2015.

A Monumental Shift

In 2015, Japan’s reduction in cigarette sales were still comparatively slow and there was a lack of lawful alternatives available for adult smokers. Yet, its advanced economy, sophisticated consumer base, and openness to new technology and innovation invited the opportunity for that to change.

That year, PMI launched its heated tobacco product (HTP) in Japan. This technology heats tobacco to a carefully controlled temperature—removing combustion from the process—allowing users to experience the flavors and nicotine they enjoy while significantly reducing their exposure to harmful and potentially harmful chemicals compared to cigarettes.

Following the launch, Japan’s rate of cigarette sales started to decline around five times faster, falling on average 9.5 percent per year from 2015 to 2018.

According to a study by researchers working for the American Cancer Society, the introduction of HTPs “likely reduced cigarette sales in Japan.” Another independent study in 2020 also concluded that “the accelerated decline in cigarette only sales in Japan since 2016 corresponds to the introduction and growth in the sales of HTPs.”

Momentum of Acceptance

Japan’s transition to HTPs has not only reflected a positive shift in nicotine consumption but also illustrated a nationwide embrace of technological advancement and new innovations that can benefit public health. The introduction of HTPs aligned perfectly with Japan's societal values, emphasizing respect for others and the environment, further encouraging the widespread acceptance and success of HTPs.

Importantly, adult smokers who had not responded to encouragement to quit cigarettes altogether, were nonetheless motivated to embrace change when given a better option than continued smoking. Key to this was providing an alternative that satisfied the various aspects users had received from smoking, whether it be sensory experience, taste, ritual, social experience, or others.

As HTPs became widely available, many smokers were encouraged by friends, families, and even companies that, if they didn’t quit, to switch to HTPs.

Driving Positive Impacts

According to the latest industry report from the Tobacco Institute of Japan, cigarette consumption decreased by 44 percent in the five years after the introduction of HTPs – the highest decline in Japan’s history. Additionally, available data shows that overall tobacco or nicotine product prevalence in Japan has not increased since HTPs were introduced in the market.

Instrumental to this success was ensuring smoke-free products were not used by those who have quit or never used nicotine-containing products. Cross-sectional surveys conclude that HTPs are of very limited interest to both adults who have never used nicotine products before and adults who had already completely stopped using nicotine products.

These data points underscore the potential of HTPs and similar innovations to offer less harmful alternatives to combustible tobacco, aligning with goals for public health improvement and harm reduction.

A Cigarette-Free Future for Texas and the United States

The journey of HTPs in Japan not only provides a blueprint for reducing smoking rates but also emphasizes the importance of adopting a multi-faceted approach to public health strategy that includes innovation, regulation, and education.

For Texas, and indeed the wider United States, these lessons can be instrumental in creating a cigarette-free America:

• Public Health Strategy: Texas should explore tailored approaches that incorporate smoke-free products into broader public health policies that adopt both traditional tobacco control measures to discourage smoking, as well as tobacco harm reduction strategies. By leveraging innovations like HTPs, public health initiatives can more effectively target the reduction of smoking rates among adults while preventing initiation among non- and never-users, including youth.

• Regulatory Framework: Learning from Japan's experience, a carefully crafted regulatory framework that encourages switching to better alternatives and enables access to current legal-age adults whilst guarding against youth access is essential.

• Community Engagement and Education: Engaging adult communities and stakeholders in educational efforts about the relative risks and benefits of smoke-free products compared to continued smoking is crucial. Clear communication and accurate information can help to navigate concerns and misconceptions, fostering an informed public discourse.

Getting There Faster

In conclusion, PMI and its U.S. affiliates stand resolutely committed to forging a cigarette-free future for Texas, the United States, and beyond. With a steadfast focus on scientific substantiation and relentless innovation, we are transforming the tobacco landscape and providing America’s approximately 28 million smokers with access to better alternatives to continued smoking.

Our journey is fueled by the belief that through rigorous science, consumer-centric innovation, and collaborative public health strategies, we can help to significantly reduce the harm caused by smoking. PMI's dedication to this vision is unwavering and we continue to pioneer pathways towards a cigarette-free America. By working together, we can get there faster.