Do perceptions of the harm of heated tobacco products differ by smoking status? A cross-sectional analysis of the Japan Society and New Tobacco Internet Survey (JASTIS) 2020 in Japan.

Introduction: Most studies have examined 'perceived harm of heated tobacco products (HTPs)' relative to combustible cigarettes (CCs). However, there is a lack of understanding regarding whether the public perceives HTPs as harmful in an absolute sense and whether this perception varies according to smoking status. Therefore, we examined the perceived absolute harm of HTPs (not relative to CCs) across different smoking statuses. Methods: We surveyed 8229 respondents (3292 females) online in Japan in 2020. Analyses were stratified by sex because of corresponding differences in smoking rates in Japan. Logistic regression was performed to calculate the ORs, adjusted for potential confounders, including age and education, of agreeing with the statements 'HTP does little harm to self' and 'HTP does no harm to others' among current smokers (CC-only, HTP-only and dual users) in reference to current non-smokers. Results: Current male smokers, particularly HTP users, were more likely to agree with 'little harm to self' than current non-smokers: ORs (95% CI, 1.64 (1.27 to 2.12), 3.08 (2.25 to 4.20) and 4.78 (3.82 to 5.97) in CC-only, HTP-only and dual users, respectively. The corresponding ORs of agreeing with 'no harm to others' in male smokers were 1.95 (1.58 to 2.42), 5.40 (4.15 to 7.01) and 4.78 (3.90 to 5.85). The results for females were qualitatively similar to those of males. Conclusions: Regardless of sexes, current smokers, particularly HTP users, tended to perceive HTP to do little harm to themselves and no harm to others in an absolute sense than current non-smokers. Providing accurate and up-to-date health information regarding HTP is crucial in minimising potential health risks to both smokers and non-smokers.