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At the start of our surveys, in 2016, about 18.5% of Japanese adults reported using TNPs

These changes were also associated with mitochondrial damage and an impaired oxidant/antioxidant balance [24,25,26], which is accompanied by excessive production of cellular ROS [27], increased pro-inflammatory responses and cellular senescence, all hallmarks of COPD [28,29,30]

Total Quit urges policymakers to take proactive steps to: Ensure appropriate access to cessation tools for smokers and nicotine users wanting to quit Regulate alternative tobacco and nicotine to protect the uptake from never smokers, in particular youth Invest in public education to promote awareness of the benefits of complete freedom from tobacco and nicotine

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