Effects of Visual Exposure to IQOS Use on Smoking Urge and Behavior

Objectives: In this study, we examined whether visual exposure to the heated tobacco product (HTP) IQOS, which was authorized for sale by the US Food and Drug Administration in 2019, acts as a cue to increase cigarette craving and smoking behavior among smokers. Methods: Young adult smokers (N = 105) were randomly assigned to view a video depicting use of either IQOS or bottled water. Main outcomes were changes in cigarette and e-cigarette desire and latency to smoke between the groups. We also examined participants' attitudes about the actors using IQOS and drinking water in the videos. Results: Exposure to the use of IQOS acutely increased observers' ratings of smoking urge and desire for a cigarette and an e-cigarette. The IQOS cue, compared with the water cue, also produced a marginally significant shorter latency to smoke. Participants perceived actors as less likeable and friendly when using IQOS than when drinking water. Conclusions: Results showed that exposure to IQOS produced smoking urge and behavior in young adult smokers, implicating IQOS use as a smoking and vaping cue. As HTPs gain popularity, product impact on passive observers should be included in their risk-benefit profile.

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Second Generation Electronic Nicotine Delivery System Vape Pen Exposure Generalizes as a Smoking Cue

Nicotine & Tobacco Research ◽

10.1093/ntr/ntw327 ◽

2017 ◽

Vol 20 (2) ◽

pp. 246-252 ◽

Cited By ~ 18

Author(s):

Andrea C King ◽

Lia J Smith ◽

Patrick J McNamara ◽

Dingcai Cao

Keyword(s):

Young Adult ◽

First Generation ◽

Second Generation ◽

Smoking Behavior ◽

Cue Exposure ◽

Similar Time ◽

Smoking Urge ◽

Nicotine Delivery ◽

Tank System ◽

And Behavior

Abstract Introduction Second generation electronic nicotine delivery systems (ENDS; also known as e-cigarettes, vaporizers or vape pens) are designed for a customized nicotine delivery experience and have less resemblance to regular cigarettes than first generation “cigalikes.” The present study examined whether they generalize as a conditioned cue and evoke smoking urges or behavior in persons exposed to their use. Methods Data were analyzed inN = 108 young adult smokers (≥5 cigarettes per week) randomized to either a traditional combustible cigarette smoking cue or a second generation ENDS vaping cue in a controlled laboratory setting. Cigarette and e-cigarette urge and desire were assessed pre- and post-cue exposure. Smoking behavior was also explored in a subsample undergoing a smoking latency phase after cue exposure (N = 26). Results The ENDS vape pen cue evoked both urge and desire for a regular cigarette to a similar extent as that produced by the combustible cigarette cue. Both cues produced similar time to initiate smoking during the smoking latency phase. The ENDS vape pen cue elicited smoking urge and desire regardless of ENDS use history, that is, across ENDS naїve, lifetime or current users. Inclusion of past ENDS or cigarette use as covariates did not significantly alter the results. Conclusions These findings demonstrate that observation of vape pen ENDS use generalizes as a conditioned cue to produce smoking urge, desire, and behavior in young adult smokers. As the popularity of these devices may eventually overtake those of first generation ENDS cigalikes, exposure effects will be of increasing importance. Implications This study shows that passive exposure to a second generation ENDS vape pen cue evoked smoking urge, desire, and behavior across a range of daily and non-daily young adult smokers. Smoking urge and desire increases after vape pen exposure were similar to those produced by exposure to a first generation ENDS cigalike and a combustible cigarette, a known potent cue. Given the increasing popularity of ENDS tank system products, passive exposures to these devices will no doubt increase, and may contribute to tobacco use in young adult smokers.

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IQOS labelling will mislead consumers

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054333 ◽

2018 ◽

Vol 27 (Suppl 1) ◽

pp. s48-s54 ◽

Cited By ~ 12

Author(s):

Karma McKelvey ◽

Lucy Popova ◽

Minji Kim ◽

Lauren Kass Lempert ◽

Benjamin W Chaffee ◽

...

Keyword(s):

Drug Administration ◽

Food And Drug Administration ◽

Health Benefits ◽

Tobacco Product ◽

Product Portfolio ◽

Measurement Instruments ◽

Philip Morris ◽

The Us ◽

Intentions To Quit ◽

System 1

BackgroundPhilip Morris International (PMI) continually expands and diversifies their nicotine product portfolio, which includes IQOS, a heated tobacco product. In December 2016, PMI filed a modified risk tobacco product (MRTP) application with the US Food and Drug Administration (FDA), seeking authorisation to market IQOS in USA with three claims of reduced harm: ‘switching completely from conventional cigarettes to the IQOS system…’ (1) ‘can reduce the risks of tobacco-related diseases;’ (2) ‘significantly reduce[s] your body’s exposure to harmful or potentially harmful chemicals;’ and (3) ‘presents less risk of harm than continuing to smoke cigarettes.’ Consumers may misunderstand what is meant by ‘switching completely'.MethodsWe critically reviewed study reports submitted to FDA by PMI in support of proposed marketing claims in its MRTP application for IQOS and focused on the statement that switching completely to IQOS reduces risk.ResultsWe found deficiencies with evidence provided by PMI supporting their assertions that: current smokers will understand what is meant by the phrase ‘switching completely'; the proposed claims will not decrease smokers’ intentions to quit; and IQOS users will in fact ‘switch completely’ from smoking cigarettes to using IQOS. The studies and measurement instruments employed by PMI suffer from design flaws and their reporting of associated findings is misleading.ConclusionConsumers will not understand the condition of the claims—that they must quit using cigarettes completely to achieve the inferred health benefits of IQOS. Rather, they are likely to misunderstand the unsupported claims of reduced risks to mean IQOS are harm-free.

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IQOS Marketing in the US: The Need to Study the Impact of FDA Modified Exposure Authorization, Marketing Distribution Channels, and Potential Targeting of Consumers

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910551 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10551

Author(s):

Carla J. Berg ◽

Lorien C. Abroms ◽

Hagai Levine ◽

Katelyn F. Romm ◽

Amal Khayat ◽

...

Keyword(s):

Young Adults ◽

Tobacco Product ◽

Target Market ◽

Direct To Consumer ◽

Tobacco Regulation ◽

The Us ◽

Potential Impact ◽

Promotional Strategies ◽

And Behavior ◽

The Impact

IQOS, the leading heated tobacco product globally, recently received ‘reduced exposure’ authorization from the US Food and Drug Administration. Independent research focusing on IQOS marketing and potential impact on consumers’ perceptions and behavior, and ultimately public health, is critical. The literature to date has underscored several concerns. First, Philip Morris’s (PM’s) marketing distribution requires scrutiny, particularly given its innovative promotional strategies. For example, IQOS is distributed via unique points-of-sale (POS; e.g., specialty and pop-up stores, “corners” in convenience stores) and uses various other opportunities (e.g., social media, sponsored events, direct-to-consumer). Second, although PM claims that IQOS’ target market is current combustible tobacco users and not young people, the literature indicates that in some populations, IQOS use is equally prominent among smokers and nonsmokers, and that specific subgroups (e.g., young adults, women) are targeted. Third, the impact of IQOS’ use of ad content promoting IQOS health benefits must be studied (e.g., how consumers interpret modified exposure messages). In conclusion, surveillance of IQOS marketing, particularly following reduced exposure authorization, is critical for obtaining valuable data to estimate population impact, particularly among population subgroups (e.g., young adults), and inform future tobacco regulation. These considerations have implications beyond IQOS—to other products and companies.

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Unboxed: US Young Adult Tobacco Users’ Responses to a New Heated Tobacco Product

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17218108 ◽

2020 ◽

Vol 17 (21) ◽

pp. 8108

Author(s):

Minji Kim ◽

Shannon Lea Watkins ◽

Kimberly A. Koester ◽

Jeremiah Mock ◽

Hyunjin Cindy Kim ◽

...

Keyword(s):

Young Adult ◽

Qualitative Method ◽

Tobacco Product ◽

High Tech ◽

Marketing Tactics ◽

Public Health Programs ◽

Sensory Experiences ◽

Novel Technology ◽

The Us ◽

Heating Technology

The heated tobacco product (HTP) IQOS was authorized for sale in the US in 2019. We investigated how young adults with experience using multiple tobacco products reacted to, perceived, and developed interest in IQOS, informing policies that might prevent HTPs from becoming ubiquitous. We used a novel qualitative method in which 33 young adult tobacco users in California (fall 2019) “unboxed” an IQOS device, tobacco sticks, and marketing materials and narrated their impressions and opinions. We conducted content and thematic analyses of participants’ reactions, sensory experiences, and interest. Multiple attributes influenced appeal for participants, including sleek electronic design, novel technology, perceived harmfulness, complexity, and high cost. The “no smoke” claim and heating technology suggested that smoking IQOS was safer than smoking cigarettes. Public health programs should closely monitor HTP marketing and uptake, particularly as “reduced exposure” claims were authorized in July 2020. Evidence-based regulations (e.g., requiring plain packaging for tobacco sticks), actions addressing IQOS’ unique attributes (e.g., regulating device packaging to reduce high-tech appeal), and public education might help to counter the appeal generated by potentially misleading IQOS marketing tactics.

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Light and mild redux: heated tobacco products’ reduced exposure claims are likely to be misunderstood as reduced risk claims

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054324 ◽

2018 ◽

Vol 27 (Suppl 1) ◽

pp. s87-s95 ◽

Cited By ~ 17

Author(s):

Lucy Popova ◽

Lauren Kass Lempert ◽

Stanton A Glantz

Keyword(s):

Tobacco Product ◽

Tobacco Products ◽

Qualitative And Quantitative ◽

Quantitative Studies ◽

Philip Morris ◽

The Us ◽

The World ◽

The Usa ◽

And Behavior ◽

Reduced Risk

IntroductionHeated tobacco products (HTPs) are being marketed in several countries around the world with claims that they are less harmful than combusted cigarettes, based on assertions that they expose users to lower levels of toxicants. In the USA, Philip Morris International (PMI) has submitted an application to the Food and Drug Administration (FDA) in 2016 seeking authorisation to market its HTPs, IQOS, with reduced risk and reduced exposure claims.MethodsWe examined the PMI’s Perception and Behavior Assessment Studies evaluating perceptions of reduced risk claims that were submitted to the FDA and made publicly available.ResultsQualitative and quantitative studies conducted by PMI demonstrate that adult consumers in the USA perceive reduced exposure claims as reduced risk claims.ConclusionThe data in the PMI modified risk tobacco product IQOS application do not support reduced risk claims and the reduced exposure claims are perceived as reduced risk claims, which is explicitly prohibited by the FDA. Allowing PMI to promote IQOS as reduced exposure would amount to a legally sanctioned repeat of the ‘light’ and ‘mild’ fraud which, for conventional cigarettes, is prohibited by the US law and the WHO Framework Convention on Tobacco Control.

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