Nationwide trends in cigarette, heated tobacco product, e-cigarette, and multiple-product use in Japan 2017-2025.

AIM: To describe nationally representative trends in overall and product-specific tobacco use, including cigarettes, heated tobacco products (HTPs), and electronic cigarettes (e-cigarettes), in Japan from 2017 to 2025. METHODS: Data came from repeated cross-sectional nationwide surveys of the Japanese population using stratified two-stage random sampling. Self-administered questionnaires assessed tobacco use. Past-30-day prevalence of overall, product-specific, and multiple-product use was estimated using survey-weighted logistic regression, with marginal predicted prevalence standardized to the 2025 age-sex structure. RESULTS: Among 16,499 participants, overall past-30-day tobacco use declined from 24.3% (95% confidence interval [CI]: 22.6-26.0%) in 2017 to 21.0% (CI: 19.4-22.7%) in 2025. Cigarette use decreased from 20.7% (CI: 19.0-22.3%) to 12.3% (CI: 11.1-13.6%), whereas HTP use increased from 5.3% (CI: 4.4-6.1%) to 11.7% (CI: 10.3-13.0%). e-cigarette use remained low, ranging from 0.7% to 1.3%. The most common multiple-product pattern was concurrent cigarette and HTP use, increasing from 2.5% (CI: 1.9-3.1%) to 4.1% (CI: 3.3-4.9%). CONCLUSION: Overall tobacco use in Japan declined modestly during 2017-2025, alongside a marked decrease in cigarette use and an increase in HTP use, while e-cigarette use remained limited. These findings suggest a shift in tobacco use, with increased HTP use partially offsetting reductions in cigarette smoking.