Association between tobacco use, including heated tobacco products, and problem gambling: A cross-sectional study

• First study examining heated tobacco products (HTPs) and problem gambling link. • 12,222 Japanese people who gambled surveyed; tobacco users and non-users analyzed. • All tobacco use patterns were associated with PG. • Dual use of cigarettes and HTPs showed notably high odds ratios for PG. • Women and younger adults showed clear tobacco-PG associations. Although smoking is a known risk factor for problem gambling, the relationship between heated tobacco products (HTPs), emerging tobacco products that are widely used in Japan, and problem gambling has not yet been examined. This study investigated the association between smoking behaviour, including HTP use, and problem gambling. We conducted a cross-sectional study using data from a large-scale online survey conducted from January 24 to February 27, 2024. Respondents who reported gambling within the past year were included in this study. Exclusive cigarette use, exclusive HTP use, and dual use were defined as smoking variables based on current smoking patterns in Japan. Problem gambling was defined as a score of 8 or higher on the Problem Gambling Severity Index. Multivariable weighted logistic regression models were fitted to examine the adjusted odds ratios (AORs) of smoking status for problem gambling. In total, 12,222 respondents (7,649 men and 4,573 women) were included in the study. The proportion of problem gambling differed; it was 4.6% among individuals who did not use tobacco products, 13.8% among those who exclusively used combustible cigarettes, 15.2% among those who exclusively used HTP, and 41.9% among those who used both. Compared to non-use/non-current use of tobacco products, exclusive combustible cigarette use (AOR, 2.89 [95% CI, 2.36–3.53]), exclusive HTP use (AOR, 2.34 [95% CI, 1.81–2.99]), and dual use (AOR, 10.52 [95% CI, 8.89–12.47]) were associated with problem gambling. Smoking behaviours, including heated tobacco product use, were associated with problem gambling