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Kim M, Vassey J, Li D, Galimov A, Han E, Kirkpatrick MG, Stanton CA, Ozga JE, Lee S, Unger JB. Discussion of Heated Tobacco Products on Twitter Following IQOS's Modified-Risk Tobacco Product Authorization and US Import Ban: Content Analysis. J Med Internet Res 2024; 26:e53938. [PMID: 39446431 DOI: 10.2196/53938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/01/2024] [Accepted: 08/14/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions. Heated tobacco products (HTPs) are an emerging tobacco product category promoted by the tobacco industry as a "better alternative" to combustible cigarettes. Philip Morris International's IQOS is leading the global HTP market and recently has been subject to important policy events, including the US Food and Drug Administration's (FDA) modified-risk tobacco product (MRTP) authorization (July 2020) and the US import ban (November 2021). Although limited in their legal implications outside the United States, these policy events have been quoted in global news outlets and Philip Morris International's promotional communications, showing how they may potentially impact global tobacco regulation. Given the impending return of IQOS to the US market, understanding how the policy events were received through social media discourse will provide valuable insights to inform global tobacco control policy. OBJECTIVE This study aims to examine HTP-related social media discourse around important policy events. METHODS We analyzed HTP-related posts on Twitter during the time period that included IQOS's MRTP authorization in the United States and the US import ban, examining personal testimonial, news/information, and direct marketing/retail tweets separately. We also examined how the tweets discussed health and policy. A total of 10,454 public English tweets (posted from June 2020 to December 2021) were collected using HTP-related keywords. We randomly sampled 2796 (26.7%) tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes. RESULTS Tweet volumes peaked around IQOS-related policy events. Among all tweets, personal testimonials were the most common (1613/2796, 57.7%), followed by news/information (862/2796, 30.8%) and direct marketing/retail (321/2796, 11%). Among personal testimonials, more tweets were positive (495/1613, 30.7%) than negative (372/1613, 23.1%), often comparing the health risks of HTPs with cigarettes (402/1613, 24.9%) or vaping products (252/1613, 15.6%). Approximately 10% (31/321) of the direct marketing/retail tweets promoted international delivery, suggesting cross-border promotion. More than a quarter of tweets (809/2796, 28.9%) discussed US and global policy, including misinterpretation about IQOS being a "safer" tobacco product after the US FDA's MRTP authorization. Neutral testimonials mentioning the IQOS brand (634/1613, 39.3%) and discussing policy (378/1613, 23.4%) showed the largest pairwise co-occurrence. CONCLUSIONS Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict tobacco marketing via the web, our results suggest that retailers may circumvent such regulations by operating overseas.
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Affiliation(s)
- Minji Kim
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Julia Vassey
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Artur Galimov
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Eileen Han
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, CA, United States
| | - Matthew G Kirkpatrick
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Jenny E Ozga
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, United States
| | - Sarah Lee
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, NY, United States
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Ganz O, Strasser AA, Giovenco DP, Audrain-McGovern J, Cappella JN, Safi Z, Tan ASL, Talbot EM, Delnevo CD. IQOS print magazine advertising characteristics and reach before and after FDA authorisation as a modified risk tobacco product. Tob Control 2024; 33:680-683. [PMID: 36958825 PMCID: PMC10517063 DOI: 10.1136/tc-2022-057741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION IQOS is a heated tobacco product that was authorised as a modified risk tobacco product (MRTP) in July 2020. While it was removed from the US market in 2021 for legal reasons, as the first tobacco product to receive an 'exposure modification' MRTP order, surveillance of IQOS marketing is needed to inform regulation and policy for future MRTPs. The purpose of this study is to expand the current research on IQOS advertising in the USA by examining content and readership characteristics of IQOS ads in print magazines before and after US Food and Drug Administration MRTP authorisation. METHODS We merged content analysis data with Kantar Media data on magazine placement and expenditures. Magazine readership data were obtained from MRI-Simmons. We compared data from pre-MRTP authorisation with data post-MRTP authorisation. This study was conducted in 2021. RESULTS There was one unique ad and there were 13 observations pre-MRTP, and eight unique ads and 132 observations post-MRTP. Compared with pre-MRTP ads, more post-MRTP ads featured Marlboro HeatSticks, including Amber HeatSticks, and featured people. All ads contained a warning label-most warning labels were cigarette specific. IQOS ads were featured in magazines that are especially popular among women. CONCLUSIONS After receiving MRTP authorisation, IQOS increased ad expenditures in print magazines with a readership comprised of primarily women. If IQOS returns to the US market, it will be important for tobacco control to monitor their advertisement content, placement, and expenditures.
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Affiliation(s)
- Ollie Ganz
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Andrew A Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Janet Audrain-McGovern
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph N Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeinab Safi
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eugene M Talbot
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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Duan Z, Berg CJ, Bar-Zeev Y, Abroms LC, Wang Y, Khayat A, Cui Y, LoParco CR, Levine H. Perceptions of Heated Tobacco Products (HTPs) Versus Cigarettes and e-Cigarettes in Relation to Likelihood of Trying HTPs or Suggesting HTPs to Those who Smoke Cigarettes. Nicotine Tob Res 2024; 26:1394-1403. [PMID: 38666732 PMCID: PMC11417126 DOI: 10.1093/ntr/ntae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/12/2024] [Accepted: 04/11/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Heated tobacco products (HTPs), like IQOS, are marketed as innovative, stylish, harm-reduction products distinct from cigarettes and e-cigarettes. Research is needed to better understand how adults who are newly introduced to HTPs perceive them relative to cigarettes and e-cigarettes, and the impact of these perceptions on use outcomes. AIMS AND METHODS We analyzed 2021 cross-sectional survey data from 1914 adults who never used HTPs from the United States and Israel, two countries where IQOS has unique histories and markets. Exploratory factor analysis examined perceptions of HTPs (vs. cigarettes and e-cigarettes) across 12 perception measures (eg, innovative, trendy, harmful, addictive). Multivariable linear regression examined these factors in relation to self-reported likelihood to: (1) "try HTPs in the next year" (1 = not-7 = extremely) and (2) "suggest IQOS to a friend who smokes cigarettes" (1 = not-5 = very), controlling for demographics and past-month cigarette and e-cigarette use (10.1% dual use, 15.4% cigarette-only, 5.7% e-cigarette-only, 68.8% neither). RESULTS Four factors were identified: HTPs' health and utility ("health-utility") and design and appeal ("design-appeal") versus cigarettes and versus e-cigarettes, separately. More favorable perceptions of HTP versus e-cigarette design-appeal (B = 0.30, 95% CI = 0.18, 0.41) were associated with greater likelihood to try HTPs. More favorable perceptions of HTP versus cigarette design-appeal (B = 0.38, 95% CI = 0.26, 0.51) and health-utility (B = 0.25, 95% CI = 0.13, 0.36), and HTP versus e-cigarette design-appeal (B = 0.32, 95% CI = 0.20, 0.45) were associated with greater likelihood to suggest HTPs to smokers. CONCLUSIONS Monitoring perceptions of HTPs versus cigarettes and e-cigarettes is critical given the role of such perceptions in HTP use and their population-level impact. IMPLICATIONS This study examined the relationship of perceptions of HTPs relative to cigarettes and e-cigarettes, with regard to adults' self-reported likelihood to use HTP or to suggest HTPs to those who smoke cigarettes. Favorable perceptions of HTPs' design and appeal versus e-cigarettes correlated with greater likelihood to try HTPs. Favorable perceptions of HTPs' design and appeal, as well as health and utility, versus cigarettes and e-cigarettes correlated with greater likelihood to suggest HTPs to those who smoke. Findings underscore the need for ongoing surveillance of HTP marketing and consumer perceptions to inform regulatory efforts and estimate the population-level impact of HTPs and other tobacco products.
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Affiliation(s)
- Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
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Momosaka T, Saito J, Otsuki A, Yaguchi-Saito A, Fujimori M, Kuchiba A, Katanoda K, Takaku R, Shimazu T. Associations of Individual Characteristics and Socioeconomic Status With Heated Tobacco Product Harmfulness Perceptions in Japan: A Nationwide Cross-sectional Study (INFORM Study 2020). J Epidemiol 2024; 34:411-418. [PMID: 38191179 PMCID: PMC11330704 DOI: 10.2188/jea.je20230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND In Japan, heated tobacco products (HTPs) are promoted by the tobacco industry as reduced-risk tobacco products despite the lack of evidence for this claim. This study determined the distribution of HTP-harmfulness perception and identified the explanatory factors associated with the perception of HTP as less harmful than conventional cigarettes. METHODS A nationwide cross-sectional survey was conducted with Japanese people aged 20 years or older (INFORM Study 2020) using a self-administered questionnaire. We performed descriptive analysis and weighted logistic regression analysis to examine the relationship between explanatory factors (eg, individual characteristics, socioeconomic status, and trusted sources of cancer information) and the perception of HTPs as less harmful. RESULTS Among 3,420 participants, the proportions of those who perceived HTPs as less harmful were 40.3% and 18.3% for users and non-users of tobacco, respectively. For participants aged 20-39 years, the proportions were 49.9% and 30.4%, respectively. Among 1,160 tobacco non-users who were familiar with HTPs, male, aged under 39 years, and having lower education were associated with the perception of HTPs as less harmful. Trusted sources of cancer information were not associated with the perception of HTPs as less harmful. CONCLUSION This study showed that, among tobacco non-users, being male, aged under 39 years, and having lower education were associated with a perception of HTPs as less harmful. Public health stakeholders should provide the latest evidence about HTP harmfulness in their daily practice and strengthen the regulations on HTP marketing directed at both tobacco- and tobacco non-users.
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Affiliation(s)
- Takumi Momosaka
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
- School of International and Public Policy, Hitotsubashi University
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
- Faculty of Human Sciences, Tokiwa University
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control
| | - Aya Kuchiba
- Graduate School of Health Innovation, Kanagawa University of Human Services
- Division of Biostatistical Research, Institution for Cancer Control/Biostatistics Division, Center for Research Administration and Support, National Cancer Center
| | - Kota Katanoda
- Division of Population Data Science, National Cancer Center Institute for Cancer Control
| | - Reo Takaku
- School of International and Public Policy, Hitotsubashi University
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control
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Khayat A, Levine H, Berg CJ, Abroms LC, Duan Z, Wang Y, LoParco CR, Elbaz D, Cui Y, Bar-Zeev Y. IQOS point-of-sale marketing: a comparison between Arab and Jewish neighborhoods in Israel. Isr J Health Policy Res 2024; 13:39. [PMID: 39152466 PMCID: PMC11328467 DOI: 10.1186/s13584-024-00626-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 08/03/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Philip Morris International's IQOS, with its heatsticks (HEETS), is the heated tobacco product with the largest global market share. IQOS and/or electronic cigarettes use rate is higher among Arabs vs. Jews in Israel. This paper aims to compare IQOS point-of-sale marketing strategies, and regulatory compliance in Arab vs. Jewish neighborhoods in Israel. METHODS We integrated data from two separate studies including a cross-sectional survey with IQOS retailers (December 2020-April 2021) and audits of points-of-sale that sold IQOS/HEETS (April 2021-July 2021) in 5 large cities in Israel, after marketing restrictions including a points-of-sale display ban and plain packaging became effective in Israel (January 2020). The survey included 69 points-of-sale (21 Arab, 48 Jewish neighborhoods) and the audits included 129 points-of-sale (48 Arab, 81 Jewish neighborhoods). Comparisons of IQOS marketing strategies between points-of-sale in Arab and Jewish neighborhoods were conducted using Chi-Square test, Fisher's exact test or Mann-Whitney test, as appropriate. Thematic analysis was used to analyze open-ended questions. RESULTS The survey showed that most marketing strategies, such as promotions to customers, were uniform across points-of-sale in Arab and Jewish neighborhoods. The most noteworthy differences were that a higher proportion of retailers from Arab neighborhoods were invited to IQOS parties (47.6% vs. 21.7%, p < 0.05) and reported personal communication with a Philip Morris International's representative (80.0% vs. 51.2%, p < 0.05). Additionally, Philip Morris International's representatives assisted points-of-sale in both Arab and Jewish neighborhoods in implementing the display ban by providing free compliant cabinets and product placement instructions, and directly interacted with customers. The audits showed that points-of-sale in Arab neighborhoods were more compliant with the display ban (25.5% vs. 8.8%, p < 0.05), but less compliant with plain packaging (62.5% vs. 79.3%, p < 0.05). CONCLUSIONS There were not many notable differences in IQOS marketing across points-of-sale in Arab vs. Jewish neighborhoods, but Philip Morris International utilized marketing elements of cultural significance, especially for points-of-sale in Arab neighborhoods, such as more personal communication and invitation to social events. Continuous surveillance of tobacco points-of-sale marketing and legislation compliance is needed, with a special focus on demographic/location-based differences.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem - Hadassah Medical Center, Ein Kerem, PO Box 12272, 911200, Jerusalem, Israel.
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem - Hadassah Medical Center, Ein Kerem, PO Box 12272, 911200, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Yan Wang
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassidy R LoParco
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Daniel Elbaz
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem - Hadassah Medical Center, Ein Kerem, PO Box 12272, 911200, Jerusalem, Israel
| | - Yuxian Cui
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem - Hadassah Medical Center, Ein Kerem, PO Box 12272, 911200, Jerusalem, Israel
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Cui Y, Bar-Zeev Y, Levine H, LoParco CR, Duan Z, Wang Y, Abroms LC, Khayat A, Berg CJ. Heated tobacco product marketing: a mixed-methods study examining exposure and perceptions among US and Israeli adults. HEALTH EDUCATION RESEARCH 2024; 39:375-397. [PMID: 38739472 PMCID: PMC11258801 DOI: 10.1093/her/cyae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/06/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
The marketing of heated tobacco products (HTPs), like IQOS, influences consumers' perceptions. This mixed-methods study analyzed (i) survey data (2021) of 2222 US and Israeli adults comparing perceptions of 7 IQOS attributes (design, technology, colors, customization, flavors, cost and maintenance) and 10 marketing messages (e.g. 'Go smoke-free…') across tobacco use subgroups and (ii) qualitative interviews (n = 84) regarding IQOS perceptions. In initial bivariate analyses, those never using HTPs (86.2%) reported the least overall appeal; those currently using HTPs (7.7%) reported the greatest appeal. Notably, almost all (94.8%) currently using HTPs also currently used cigarettes (82.0%) and/or e-cigarettes (64.0%). Thus, multivariable linear regression accounted for current cigarette/e-cigarette use subgroup and HTP use separately; compared to neither cigarette/e-cigarette use (62.8%), cigarette/no e-cigarette use (17.1%) and e-cigarette/no cigarette use (6.5%), those with dual use (13.5%) indicated greater overall IQOS appeal (per composite index score); current HTP use was not associated. Qualitative data indicated varied perceptions regarding advantages (e.g. harm, addiction and complexity) of IQOS versus cigarettes and e-cigarettes, and perceived target markets included young people, those looking for cigarette alternatives and females. Given the perceived target markets and particular appeal to dual cigarette/e-cigarette use groups, IQOS marketing and population impact warrant ongoing monitoring to inform regulation.
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Affiliation(s)
- Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, 7 Ramat Gan, Jerusalem, 9112102, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, 7 Ramat Gan, Jerusalem, 9112102, Israel
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC 20052, USA
| | - Zongshuan Duan
- School of Public Health, Georgia State University, 140 Decatur St. SE, Atlanta, GA 30303, USA
| | - Yan Wang
- GW Cancer Center, George Washington University, 800 22nd Street NW, Washington, DC 20052, USA
| | - Lorien C Abroms
- GW Cancer Center, George Washington University, 800 22nd Street NW, Washington, DC 20052, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, 7 Ramat Gan, Jerusalem, 9112102, Israel
| | - Carla J Berg
- GW Cancer Center, George Washington University, 800 22nd Street NW, Washington, DC 20052, USA
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Khayat A, Bar-Zeev Y, Kaufman Y, Berg C, Abroms L, Duan Z, LoParco CR, Wang Y, Cui Y, Levine H. IQOS news media coverage in Israel: a comparison across three subpopulations. Tob Control 2024:tc-2023-058422. [PMID: 39013604 DOI: 10.1136/tc-2023-058422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/21/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Philip Morris International's (PMI) IQOS, a leading heated tobacco product globally, entered the Israeli market in 2016. IQOS and/or electronic cigarette use is higher in Israel's Arab population (2.8% vs 1.2% of Jews). However, previous research indicated possible targeting of the Ultra-orthodox Jewish population with more IQOS paid ads. This paper examined how IQOS is framed in news media articles directed at three subpopulations in Israel: Arab, Ultra-orthodox Jews and general public. METHODS Media articles (January-October 2020) were obtained from Ifat media and were coded using abductive coding. Characteristics of articles (photo and article content) targeting each subpopulation were compared using χ2, Fisher's exact test, one-way analysis of variance and median test, as appropriate. RESULTS Of the 63 unique articles identified, 16 targeted Arab, 24 Ultra-orthodox Jews and 23 general public. Arab and Ultra-orthodox Jewish media significantly differed from the general public's media in their positive framing of PMI (100% Arab and 75% Ultra-orthodox Jews vs 52% general public, p=0.004), and IQOS (100% Arab and 88% Ultra-orthodox Jews vs 61% general public, p=0.006). Arab media differed from others by highlighting IQOS' retail locations (81% vs 17% Ultra-orthodox Jews and 13% general public), social benefits (88% vs 8% Ultra-orthodox Jews and 17% general public) and reflecting content from PMI's press release (100% vs 46% Ultra-orthodox Jews and 35% general public; ps <0.001). CONCLUSIONS IQOS was framed more positively in media targeting minority populations (Arab and Ultra-orthodox Jews), compared with general public. Arabic media in particular emphasised IQOS' retail accessibility and social benefits. These findings highlight the need for media surveillance and regulation, especially of minority-oriented media.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - Yechiel Kaufman
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - Carla Berg
- Department of Prevention and Community Health, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Lorien Abroms
- Department of Prevention and Community Health, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Zongshuan Duan
- Department of Population Health Sciences, Georgia State University, Atlanta, Georgia, USA
| | - Cassidy R LoParco
- Department of Prevention and Community Health, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Yan Wang
- Department of Prevention and Community Health, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Yuxian Cui
- Department of Prevention and Community Health, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Hadassah Medical Center, Jerusalem, Israel
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8
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Abroms LC, Wysota CN, Tosakoon S, Khayat A, Duan Z, Bar-Zeev Y, Berg CJ, Levine H. Industry marketing of tobacco products on social media: case study of Philip Morris International's IQOS. Tob Control 2024; 33:518-524. [PMID: 36927516 DOI: 10.1136/tc-2022-057833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
SIGNIFICANCE Newer tobacco products might be particularly likely to use social media as they emerge in the global market. Little is known about the official use of social media in marketing heated tobacco products (HTPs). This study examined Philip Morris International's (PMI) social media marketing globally of its leading HTP, IQOS. METHODS PMI IQOS country-specific official websites were accessed (N=59) in May to September 2022 and social media accounts listed were recorded. Accounts were then coded for their number of posts in the past month and year and for their number of subscribers. Posts on online accounts with at least one past-month post were categorised to describe the post's function: instructional, general advertising, price promotions or event promotions. RESULTS Of the 59 country websites, 45 (76.3%) listed at least one social media account; of these, an average of 2.5 accounts (SD=0.8) were listed. Across websites, 111 accounts were identified: 42 Facebook, 23 YouTube, 21 Twitter, 19 Instagram, 2 Telegram, 1 LinkedIn, 1 KakaoTalk, 1 VK and 1 LINE. Across YouTube, Twitter and Instagram, accounts made 2550 past-year posts and had ~490 961 subscribers. Of the 165 past-month posts, 101 (60.1%) functioned as general advertising, 30 (17.9%) instructional, 29 (17.3%) event promotions and 8 (4.8%) price promotions. CONCLUSION Social media posts were used to engage consumers with advertising, event promotions, product use instructions and price promotions. The study provides evidence of the company-sponsored official marketing of an HTP via social media globally, underscoring the need for monitoring and tobacco control regulatory efforts in the digital arena.
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Affiliation(s)
- Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- Institute for Data Democracy & Health, The George Washington University, Washington, DC, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- Institute for Data Democracy & Health, The George Washington University, Washington, DC, USA
| | - Sararat Tosakoon
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- George Washington University Cancer Center, George Washington University, Washington, DC, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
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Audrain-McGovern J, Wileyto EP, Klapec O, Koita F, Strasser AA. Switching from cigarettes to IQOS: the relative importance of IQOS-associated reward, reinforcement and abstinence relief. Tob Control 2024:tc-2024-058635. [PMID: 38871445 DOI: 10.1136/tc-2024-058635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION This study investigated whether IQOS, a heated tobacco product, can fully substitute for combustible cigarettes and the factors that promote substitution. METHODS Adults who smoked cigarettes daily (N=90; 21-65 years) completed a baseline ad-lib smoking period (days 1-5), two laboratory visits (days 6-7) and a 2-week period where they were instructed to switch from smoking cigarettes to using IQOS 3.0 (days 8-21). Mixed-effect modelling estimated the changes in cigarettes per day (CPD) and the percentage of baseline CPD substituted by HeatSticks during the switch period. Predictors included IQOS-associated subjective reward, relative reinforcing value, craving relief and withdrawal relief. RESULTS Participants reduced their CPD to about 30% of their baseline smoking rate by the end of the 14-day switch period (p<0001). A lower versus higher reinforcing value of smoking relative to IQOS (RRV; break point <5 vs ≥5) predicted greater reductions in CPD (β=-1.31 (95% CI -2.35 to -0.27) p=0.013). Initially, IQOS use was 72% of the baseline smoking rate (β=71.64 (95% CI 42.79 to 100.48) p<0.0001) and climbed by 0.8% per day (β=0.82 (95% CI 0.01 to 1.64) p=0.05), for an average substitution rate of 83%. The subjective reward of IQOS was the only predictor of a higher substitution rate (β=4.26 (95% CI 1.03 to 7.50) p=0.01). CONCLUSIONS IQOS fully substituted for cigarettes in ~20% of people who were not immediately interested in quitting smoking while the remainder significantly reduced their smoking. Positive reinforcing effects of IQOS foster use and the transition away from combustible cigarettes. TRIAL REGISTRATION NUMBER NCT05076708.
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Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - E Paul Wileyto
- Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Olivia Klapec
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fodie Koita
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Frino-García A, Pérez Rodas EN, Hernández-González F, Alsina-Restoy X, Kette-Aguilera P, Jiménez Ruiz C, Castedo CR, De Granda-Orive JI, Riesco Miranda JA, Sellares J. Everyone was Fooled, it Burns: Simple Diy Proof of the Falsity of Heat-Not-Burn Tobacco. Arch Bronconeumol 2024; 60:316-318. [PMID: 38429133 DOI: 10.1016/j.arbres.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 03/03/2024]
Affiliation(s)
| | | | | | | | | | - Carlos Jiménez Ruiz
- Hospital Clinic, Barcelona, Spain; University Hospital Complex, Santiago De Compostela, Spain; Respiratory Department, 12 of October University Hospital, Complutense University, Madrid, Spain
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11
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Khayat A, Levine H, Berg CJ, Shauly-Aharonov M, Manor O, Abroms L, Romm KF, Wysota CN, Bar-Zeev Y. IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis. Tob Control 2024; 33:e3-e10. [PMID: 36368887 PMCID: PMC10172385 DOI: 10.1136/tc-2022-057585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International's (PMI) IQOS and cigarette advertisements. METHODS Weekly number of ads and weekly adspend of PMI's IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regressions over time, across regulatory periods and in relation to subpopulations (general public, Arab, Russian and Ultra-Orthodox), from 25 December 2016 to 4 August 2020. Exponentiated coefficients (a value >1 indicates an increase) and 95% CIs are reported. RESULTS The average weekly number of ads and the average weekly adspend of IQOS were higher than cigarettes (42.22 vs 26.76 ads/week and 59 409 vs 45 613 new Israeli shekels/week; p<0.001 for both) during the study period, with exclusive IQOS advertisements during market penetration (December 2016 to May 2017). Variation in both outcomes was observed with regard to regulatory decisions. After the advertisement ban, there was a significant decrease in the weekly number of ads (IQOS: ß=0.04, 95% CI 0.002 to 0.20; cigarettes: ß=0.05, 95% CI 0.01 to 0.15) and weekly adspend (IQOS: ß=0.15, 95% CI 0.07 to 0.29; cigarettes: ß=0.31, 95% CI 0.17 to 0.53) for both products. The Ultra-Orthodox had significantly higher average weekly ads compared with the Arab population (IQOS: 0.67 vs 0.07; cigarettes: 2.74 vs 0.13; p=0.02 for both) but lower adspend. CONCLUSIONS IQOS and cigarette advertisements varied over time and appeared to have been impacted by regulatory changes. PMI invested more in IQOS advertisements than in cigarettes, with a partial advertisement ban decreasing both products' advertisements. PMI might be targeting the Ultra-Orthodox Jewish population which has a low smoking rate. Further research and surveillance are needed to better understand targeting strategies in order to inform tobacco control policy.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michal Shauly-Aharonov
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Khayat A, Berg CJ, Levine H, Rodnay M, Abroms L, Romm KF, Duan Z, Bar-Zeev Y. PMI's IQOS and cigarette ads in Israeli media: a content analysis across regulatory periods and target population subgroups. Tob Control 2024; 33:e54-e61. [PMID: 36418166 PMCID: PMC10203057 DOI: 10.1136/tc-2022-057671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND IQOS, manufactured by Philip Morris International (PMI), is the highest selling heated tobacco product globally. IQOS went through several regulatory changes in Israel: from no oversight to minimal tobacco legislation, to progressive legislation that included a partial advertisement ban (exempting print media) and plain packaging. We examined how PMI's advertising messages changed during these regulatory periods for both IQOS and cigarettes. METHODS Content analysis of PMI's IQOS and cigarette ads was performed using a predefined framework. Ad characteristics included regulatory period, target population, setting, product presentation, age and use restrictions, retail accessibility, additional detail cues (eg, QR code) and promotions. Ad themes included product features, legislation-related elements, social norms and comparative claims. Comparisons between IQOS and cigarette ads, and across regulatory periods, were examined using χ2 test or Fisher's exact test. RESULTS The dataset included 125 IQOS ads and 71 cigarette ads. IQOS ads featured more age restrictions, retail accessibility and additional detail cues, compared with cigarette ads (93.6% vs 16.9%; 56.0% vs 0.0%; and 95.2% vs 33.8%, p<0.001 for all). Cigarette ads featured mostly price promotions (52.1% vs 10.1% of IQOS ads, p<0.001). The main ad themes were technology for IQOS (85.6%) and quality for cigarettes (50.7%). In later (vs earlier) restrictive regulatory periods, IQOS ads featured more direct comparisons to cigarettes, QR codes and indoor settings, and did not feature product packaging. CONCLUSIONS IQOS advertisement content shifted as more restrictions went into effect, with several elements used to circumvent legislation. Findings from this study point to the necessity of a complete advertisement ban and ongoing marketing surveillance.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Rodnay
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Berg CJ, Duan Z, Wang Y, Thrasher JF, Bar-Zeev Y, Abroms LC, Romm KF, Khayat A, Levine H. Impact of FDA endorsement and modified risk versus exposure messaging in IQOS ads: a randomised factorial experiment among US and Israeli adults. Tob Control 2024; 33:e69-e77. [PMID: 36428095 PMCID: PMC11347710 DOI: 10.1136/tc-2022-057639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND IQOS was the first heated tobacco product to receive Food and Drug Administration (FDA) authorisation for 'reduced exposure' marketing claims, which has been exploited globally. METHODS In November-December 2021, we conducted a survey-based 3×3 factorial experiment among US (n=1128) and Israeli adults (n=1094). We presented: (1) reduced exposure, reduced risk and control messaging and (2) 2 variations of FDA endorsement and control messaging. Each participant was randomly assigned to evaluate 2 ads (displayed on different ad imagery), then completed assessments of perceived relative harm, exposure and disease risk and likelihood of personally trying or suggesting IQOS to smokers. Ordinal logistic regression examined messaging conditions and their interactions, on the 5 outcomes, respectively, adjusting for covariates. RESULTS Control (vs reduced exposure) messaging resulted in higher perceived relative harm (adjusted OR (aOR)=1.29, 95% CI=1.12 to 1.48), exposure (aOR=1.34, 95% CI=1.17 to 1.54) and disease risk (aOR=1.23; 95% CI=1.08 to 1.40), and lower likelihood of suggesting IQOS to smokers (aOR=0.85; 95% CI=0.74 to 0.97). Reduced risk (vs exposure) messaging resulted in lower perceived relative harm (aOR=0.86; 95% CI=0.75 to 0.99). One FDA endorsement message ('IQOS (completed) the US FDA examination of tobacco products. FDA concluded that IQOS is a better choice for adult smokers') was associated with greater likelihood of suggesting IQOS to smokers, relative to control (aOR=1.19; 95% CI=1.04 to 1.37). No interactions between risk/exposure messaging and FDA endorsement messaging were found. Additionally, Israeli participants, cigarette users and men perceived lower relative harm and exposure and greater likelihood of trying or suggesting IQOS to smokers. CONCLUSIONS Regulators must monitor direct and indirect advertising content of modified risk tobacco product-authorised products and prevent potentially harmful misinterpretations.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Yan Wang
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine; TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
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Khayat A, Levine H, Berg CJ, Abroms LC, Duan Z, Wang Y, LoParco CR, Elbaz D, Cui Y, Bar-Zeev Y. IQOS point-of-sale marketing: a comparison between Arab and Jewish neighborhoods in Israel. RESEARCH SQUARE 2024:rs.3.rs-3953025. [PMID: 38464035 PMCID: PMC10925470 DOI: 10.21203/rs.3.rs-3953025/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Philip Morris International's (PMI) IQOS, with its heatsticks (HEETS), is the heated tobacco product with the largest global market share. IQOS and/or electronic cigarettes use rate is higher among Arabs vs. Jews in Israel. This paper aims to compare IQOS point-of-sale (POS) marketing strategies, and regulatory compliance in Arab vs. Jewish neighborhoods in Israel. Methods We integrated data from two separate studies including a cross-sectional survey with IQOS retailers (December 2020-April 2021) and audits of POS that sold IQOS/HEETS (April 2021-July 2021) in 5 large cities in Israel, after marketing restrictions including a POS display ban and plain packaging became effective in Israel (January 2020). The survey included 69 POS (21 Arab, 48 Jewish neighborhoods) and the audits included 129 POS (48 Arab, 81 Jewish neighborhoods). Comparisons of IQOS marketing strategies between POS in Arab and Jewish neighborhoods were conducted using Chi-Square test, Fisher's exact test or Mann-Whitney test, as appropriate. Thematic analysis was used to analyze open-ended questions. Results Most marketing strategies, such as promotions to customers, were uniform across POS in Arab and Jewish neighborhoods. The most noteworthy differences were that a higher proportion of retailers from Arab neighborhoods were invited to IQOS parties (47.6% vs. 21.7%, p<0.05) and reported personal communication with a PMI representative (80.0% vs. 51.2%, p<0.05). Additionally, PMI representatives assisted POS in both Arab and Jewish neighborhoods in implementing the display ban by providing free compliant cabinets and product placement instructions, and directly interacted with customers. POS in Arab neighborhoods were more compliant with the display ban (25.5% vs. 8.8%, p<0.05), but less compliant with plain packaging (62.5% vs. 79.3%, p<0.05). Conclusions There were not many notable differences in IQOS marketing across POS in Arab vs. Jewish neighborhoods, but PMI utilized marketing elements of cultural significance, especially for POS in Arab neighborhoods, such as more personal communication and invitation to social events. Continuous surveillance of tobacco POS marketing and legislation compliance is needed, with a special focus on demographic/location-based differences.
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Affiliation(s)
- Amal Khayat
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
| | - Hagai Levine
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
| | - Carla J Berg
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Lorien C Abroms
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | | | - Yan Wang
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Cassidy R LoParco
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Daniel Elbaz
- Hebrew University of Jerusalem Faculty of Medicine
| | - Yuxian Cui
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Yael Bar-Zeev
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
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Henderson KC, Kute NG, Popova L, Ashley DL, Spears CA, Churchill V, Weaver SR, Pechacek TF, Huang J. Content analysis of IQOS direct mail and email marketing in the US. Prev Med Rep 2024; 38:102634. [PMID: 38375169 PMCID: PMC10874834 DOI: 10.1016/j.pmedr.2024.102634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/21/2024] Open
Abstract
Objective Novel nicotine and tobacco products, including heated tobacco products (HTPs) like IQOS, are growing in global popularity. IQOS was the first HTP authorized for sale by the US Food and Drug Administration, entering the US market in 2019 and being removed in 2021 due to patent-related legal challenges, with the possibility of returning in 2024. Direct marketing is one method tobacco companies use to reach consumers of these products. The purpose of this study was to investigate the content of US IQOS direct mail and email marketing. Methods Direct marketing items were collected between September 2019 and July 2021 by seven team members in the first US IQOS test market, Atlanta, Georgia. Results Overall, 101 marketing items were collected, 59 of which were unique. Among the unique items that showed images of persons ("models"), 70 % showed models appearing to be from racial/ethnic minoritized groups, 86.8 % showed at least one female-presenting model, and 37.5 % showed models appearing to be young adults (18-29 years). Items often had an embedded link/URL (91.5 %) and mentioned topics such as online services (54.2 %; for example, online ordering and tutorials), user experience (49.2 %), social media (44.1 %), and purchasing locations (37.3 %). When examined for their main purpose, items focused on subjects such as store experience (37.7 %), product introduction (18.6 %), and product use (15.3 %). Conclusions Our study highlights the importance of better understanding how novel tobacco products are marketed, which can inform policymakers' regulatory efforts and product authorization decisions.
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Affiliation(s)
| | - Nikita G. Kute
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - David L. Ashley
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Claire A. Spears
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Victoria Churchill
- Cancer Health Equity Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Scott R. Weaver
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | | | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA, USA
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Duan Z, Abroms LC, Cui Y, Wang Y, LoParco CR, Levine H, Bar-Zeev Y, Khayat A, Berg CJ. Exposure to e-cigarette advertisements and non-advertising content in relation to use behaviors and perceptions among US and Israeli adults. Tob Prev Cessat 2023; 9:35. [PMID: 38033881 PMCID: PMC10685321 DOI: 10.18332/tpc/173558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION As e-cigarette marketing strategies diversify, it is important to examine exposure to and impact of e-cigarette advertisements and non-advertising content (e.g. on social media) via multiple media channels among adults in different regulatory contexts. METHODS Using 2021 cross-sectional data among 2222 adults in the US (n=1128) and Israel (n=1094), multivariable regression examined past-month e-cigarette advertisement and non-advertising content exposure in relation to past-month e-cigarette use (logistic regression), as well as use intentions and risk perceptions (linear regressions), controlling for sociodemographics and tobacco use. RESULTS Overall, 20.3% reported past-month e-cigarette use (15.5% US, 25.2% Israel), 46.1% any advertisement exposure (28.7% digital media, 25.2% traditional media, 16.8% retail settings), and 34.1% any non-advertising exposure (19.4% social media, 13.6% websites, 12.3% movie/television/theater, 5.8% radio/podcasts). Exposure to digital media advertisements (AOR=1.95; 95% CI: 1.42-2.66), traditional media advertisements (AOR=2.00; 95% CI=1.49-2.68), and social media non-advertising (AOR=1.72; 95% CI: 1.25-2.36) correlated with e-cigarette use. Exposure to traditional media advertisements (β=0.23; 95% CI: 0.08-0.38) and social media non-advertising (β=0.26; 95% CI: 0.09-0.43) correlated with use intentions. Exposure to digital media advertisements (β= -0.32; 95% CI: -0.57 - -0.08), retail setting advertisements (β= -0.30; 95% CI: -0.58 - -0.03), and radio/podcast non-advertising (β= -0.44; 95% CI: -0.84 - -0.03) correlated with lower perceived addictiveness. Radio/podcast non-advertising exposure (β= -0.50; 95% CI: -0.84 - -0.16) correlated with lower perceived harm. However, retail setting advertisement exposure was associated with e-cigarette non-use (AOR=0.61; 95% CI: 0.42-0.87), and traditional media advertisement (β=0.38; 95% CI: 0.15-0.61) and social media non-advertising exposure (β=0.40; 95% CI: 0.14-0.66) correlated with greater perceived addictiveness. CONCLUSIONS E-cigarette-related promotional content exposure across media platforms impacts perceptions and use, thus warranting regulation.
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Affiliation(s)
- Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, United States
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
| | - Cassidy R. LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
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Duan Z, Levine H, Bar-Zeev Y, Cui Y, LoParco CR, Wang Y, Abroms LC, Khayat A, Berg CJ. Health warning labels on heated tobacco products and their impact on use intentions and risk perceptions: a cross-sectional study of adult tobacco users in the US and Israel. Isr J Health Policy Res 2023; 12:33. [PMID: 37957696 PMCID: PMC10644544 DOI: 10.1186/s13584-023-00582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Health warning labels (HWLs) represent an evidence-based tobacco control strategy; however, their application to heated tobacco products (HTPs) and related impacts are understudied. This study examined the impact of HTP HWLs on HTP use intentions and risk perceptions among current tobacco users. METHODS We analyzed cross-sectional survey data from adults in the US and Israel reporting past-month tobacco use and awareness of HTPs (N = 424). Multivariate analyses examined: (1) sociodemographics in relation to self-reported impact of HTP HWLs (i.e., more concerned about HTP use, reassured, no effect [referent]) among those who noticed HTP HWLs (multinomial regressions); and (2) HWL impacts in relation to HTP use intentions and perceived addictiveness and harm (linear regressions). RESULTS Among participants who noticed HTP HWLs (n = 372, 87.7%), 27.7% reported HWLs increased their concerns about HTP use, 22.6% were reassured about use, and 49.7% reported no effect. Factors associated with increased concern (vs. no effect) included other tobacco product use (aOR = 2.10, 95% CI 1.21-3.64) and being female (aOR = 1.77, 95% CI 1.03-3.05). Factors associated with being reassured about HTPs use (vs. no effect) included current HTP use (aOR = 2.11, 95% CI 1.11-4.00) and being from Israel (vs. US: aOR = 3.85, 95% CI 1.85-7.69), female (aOR = 1.91, 95% CI 1.07-3.42), and less educated (< college education: aOR = 2.57, 95% CI 1.42-4.63). Reporting that HWLs on HTPs increased concern (β = 0.46, 95% CI 0.03-0.89) and reassured of use (β = 0.94, 95% CI 0.47-1.41) were positively associated with HTP use intentions; no associations with risk perceptions were found. CONCLUSIONS Findings indicate that most tobacco users noticed HWLs on HTPs, but the majority reported no effect or being reassured of using HTPs, effects that were magnified for specific subgroups. Both increased concern and reassurance correlated with greater use intentions. Additional research should evaluate HTP HWL impacts and ensure effectiveness in communicating risks and discouraging use.
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Affiliation(s)
- Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
- George Washington Cancer Center, George Washington University, Washington, DC, USA.
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Kim K. Scanned information exposure and support for tobacco regulations among US youth and young adult tobacco product users and non-users. HEALTH EDUCATION RESEARCH 2023; 38:426-444. [PMID: 37565566 PMCID: PMC10516358 DOI: 10.1093/her/cyad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023]
Abstract
The influences of information exposure on youth and young adults' (YYA) support for smoking/vaping regulations have been understudied. This study examines (i) the relationships between routine exposure to (i.e. scanning) anti-smoking/pro-vaping information and YYA support for anti-smoking/vaping regulations and (ii) whether these relationships differ across YYA users and non-users of tobacco products. We analyzed the data from a nationally representative two-wave rolling cross-sectional survey of YYA in the United States, collected from 2014 to 2017 (baseline n = 10 642; follow-up n = 4001). Less than 5% of the participants ever scanned pro-smoking and anti-vaping information. Scanning anti-smoking information had significant positive relationships with support for all anti-smoking policies cross-sectionally, and this pattern was longitudinally significant in two anti-smoking policy contexts. Scanning pro-vaping information had significant negative associations with support for anti-vaping policies cross-sectionally, but not longitudinally. The lagged positive relationships between scanning anti-smoking information and support for anti-smoking regulations were stronger among YYA smokers than among YYA non-smokers, whereas evidence from adult data suggested the opposite pattern. The findings suggest that scanning information can affect YYA support for tobacco regulations. Future efforts are required to investigate mechanisms underlying the influences of scanned information on YYA support for tobacco regulations.
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Affiliation(s)
- Kwanho Kim
- Department of Communication, Cornell University, 494 Mann Library Building, Ithaca, NY 14853, USA
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19
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Duan Z, Levine H, Romm KF, Bar-Zeev Y, Abroms LC, Griffith L, Wang Y, Khayat A, Cui Y, Berg CJ. IQOS Marketing Strategies and Expenditures in the United States From Market Entrance in 2019 to Withdrawal in 2021. Nicotine Tob Res 2023; 25:1798-1803. [PMID: 37338204 PMCID: PMC10475495 DOI: 10.1093/ntr/ntad096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/10/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION IQOS entered the U.S. market in October 2019, then received the Food and Drug Administration (FDA)'s modified risk tobacco product authorization (MRTPA) allowing use of "reduced exposure" claims in marketing in July 2020. A May 2021 court decision regarding patent infringement required IQOS' removal from the U.S. market in November 2021. AIMS AND METHODS Using 2019-2021 Numerator marketing data, this study characterized ad occurrences and expenditures-including allocation per ad content (headline theme, imagery) and media type and channel-pre- and post-MRTPA; exploratory analyses characterized the post-court to withdrawal period separately. RESULTS The study period entailed 685 occurrences and $15 451 870 in expenditures. The proportions of occurrences across the three periods (pre-MRTPA, post-MRTPA, and post-court) were 39.3%, 48.8%, and 12.0%, respectively (p < .001); the proportions of expenditures were 8.6%, 30.0%, and 61.5%. Overall, 73.1% of ad occurrences were via online display; 99.6% of expenditures occurred in print. Per occurrences, prominent pre-MRTPA headline themes included "future" (40.2%), "real tobacco" (38.7%), "get IQOS" (35.3%), and "innovation or technology" (20.1%); post-MRTPA, prominent themes included "not burned or heat control" (32.7%), "reduced exposure" (26.4%), and "distinct from e-cigarettes" (20.7%). Visuals mainly depicted the product alone (pre-MRTPA: 86.6%; post-MRTPA: 76.1%), but increasingly featured women (pre-MRTPA: 8.6%; post-MRTPA: 21.5%). The most prominent media channel theme pre-MRTPA was "technology" (19.7%), but post-MRTPA included "women's fashion" (20.4%) and "entertainment or pop culture/gaming" (19.0%). CONCLUSIONS IQOS leveraged MRTPA in ads, continued marketing post-court decision, and targeted key consumer groups (ie, women). Marketing surveillance of products granted MRTPA is needed, domestically and in other countries, to assess its use and impact. IMPLICATIONS Philip Morris (PM) leveraged IQOS' MRTPA from the U.S. FDA, and continued marketing IQOS after its withdrawal from the U.S. market due to a patent-infringement-related court decision. Notably, IQOS marketing increasingly targeted key consumer groups (eg, women). Given IQOS' potential return to the United States, PM's use of FDA's MRTPA to promote IQOS as a risk reduction product in other countries, and FDA's MRTPA for other products, it is crucial to monitor products receiving MRTPA, their marketing, and their population impact, domestically and in other countries.
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Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, Univeristy of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | | | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
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20
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Berg CJ, Duan Z, Wang Y, Thrasher JF, Abroms LC, Khayat A, Romm KF, Levine H, Bar-Zeev Y. Impact of different health warning label and reduced exposure messages in IQOS ads on perceptions among US and Israeli adults. Prev Med Rep 2023; 33:102209. [PMID: 37223575 PMCID: PMC10201851 DOI: 10.1016/j.pmedr.2023.102209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/16/2022] [Accepted: 04/12/2023] [Indexed: 05/25/2023] Open
Abstract
Heated tobacco products (HTPs; e.g., IQOS) are advertised as safer than cigarettes or an alternative, yet required health warning labels (HWLS) in many countries, including the US and Israel, do not consider whether HTP ads undermine HWLs, particularly those that do not explicitly address HTPs. In 2021, a randomized 4 × 3 factorial experiment among 2,222 US and Israeli adults examined IQOS ads with differing: 1) HWLs (i.e., smoking risks, prompt to quit, HTP-specific, control); and 2) ad messages (i.e., slight distancing: "cigarette-like satisfaction, no odor", clear distancing: "looking for an alternative?", control). Outcomes were perceived relative harm (vs cigarettes), exposure to harmful chemicals, and disease risk and likelihood of trying or suggesting IQOS to smokers. Ordinal logistic regression was used, adjusted for covariates. One HWL effect was found: risk (vs control) increased perceived relative harm (aOR = 1.21, CI = 1.03-1.41) and exposure (aOR = 1.22, CI = 1.04-1.42) and decreased likelihood of trying IQOS (aOR = 0.82, CI = 0.69-0.97). Both slight and clear distancing ads (vs control) decreased perceived harm (aOR = 0.85, CI = 0.75-0.97; aOR = 0.63, CI = 0.55-0.72, respectively) and increased likelihood of suggesting IQOS to smokers (aOR = 1.23, CI = 1.07-1.41; aOR = 1.28, CI = 1.11-1.47); slight distancing decreased perceived disease risk (aOR = 0.85, CI = 0.75-0.97); and clear distancing decreased perceived exposure (aOR = 0.73, CI = 0.64-0.83). Clear (vs slight) distancing decreased perceived relative harm (aOR = 0.74, CI = 0.65-0.85) and exposure (aOR = 0.82, CI = 0.71-0.93). One interaction effect was found: the quitting HWL and clear distancing led to particularly low perceived relative harm (aOR = 0.63, CI = 0.43-0.93). Regulatory agencies must monitor the impacts of advertising, including reduced risk/exposure messaging on perceptions of HWL messages, to inform future regulatory efforts.
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Affiliation(s)
- Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - James F. Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Katelyn F. Romm
- TSET Health Promotion Research Center, Stephenson Cancer Center; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
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Martín-Álvarez JM, Almeida A, Golpe AA, Asensio E. Electronic device or regulated tobacco product? Learning from the diffusion of heated tobacco products in Spain. Public Health 2023; 219:61-66. [PMID: 37119795 DOI: 10.1016/j.puhe.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES Tobacco companies have introduced heated tobacco product (HTP) in many countries and marketed it on the grounds that it is a less harmful alternative to health. However, tobacco companies have been widely criticized for taking advantage of a loophole that allows electronic devices to circumvent regulations limiting tobacco advertising. This work aims to determine whether HTPs respected the rules that regulate tobacco advertising when it was introduced in Spain. STUDY DESIGN This is an observational epidemiological study. METHODS Using monthly time series data from September 2016 to June 2020, we analyzed whether the adoption of HTPs has followed the same behavior patterns as other brands that were introduced under the same conditions of use. The Bass model is used to analyze the diffusion of HTPs, and 30 other traditional cigarette brands introduced under the same conditions as this HTPs. RESULTS The adoption of HTPs in Spain has been like that of brands of slim cigarettes that are mistakenly considered to be healthier than traditional cigarettes. The results indicate that the use of HTPs has spread in the same way as additive-free and ultra-slim cigarette brands. CONCLUSIONS Policymakers should keep in mind that laws should restrict any marketing of tobacco products that promotes positive connotations between tobacco use and being healthy. If manufacturers are allowed to classify a category and/or brand of tobacco products as less harmful to health, the imitation effect is very high, leading to the proliferation of smoking.
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Affiliation(s)
- J M Martín-Álvarez
- Department of Quantitative Analysis International University of La Rioja Spain
| | - A Almeida
- Department of Quantitative Analysis International University of La Rioja Spain
| | - A A Golpe
- Department of Economics and Centro de Estudios Avanzados en Física, Matemáticas y Computación, University of Huelva, Spain.
| | - E Asensio
- Department of Quantitative Analysis International University of La Rioja Spain
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Levine H, Duan Z, Bar-Zeev Y, Abroms LC, Khayat A, Tosakoon S, Romm KF, Wang Y, Berg CJ. IQOS Use and Interest by Sociodemographic and Tobacco Behavior Characteristics among Adults in the US and Israel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3141. [PMID: 36833831 PMCID: PMC9961058 DOI: 10.3390/ijerph20043141] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Heated tobacco products (HTPs) have expanded globally. IQOS, a global HTP leader, was launched in Israel in 2016 and the US in 2019. To inform tobacco control efforts, it is critical to understand who is likely to use HTPs in different countries with distinct regulatory and marketing contexts. Thus, we conducted a cross-sectional survey among adult (ages 18-45) online panelists in the US (n = 1128) and Israel (n = 1094), oversampling tobacco users, in the fall of 2021, and used multivariable regression to identify correlates of (1) ever using IQOS; (2) past-month vs. former among ever users; and (3) interest in trying IQOS among never users. Among US adults, correlates of ever use included being Asian (aOR = 3.30) or Hispanic (aOR = 2.83) vs. White, and past-month use of cigarettes (aOR = 3.32), e-cigarettes (aOR = 2.67), and other tobacco (aOR = 3.34); in Israel, correlates included being younger (aOR = 0.97), male (aOR = 1.64), and cigarette (aOR = 4.01), e-cigarette (aOR = 1.92) and other tobacco use (aOR = 1.63). Among never users, correlates of greater interest included cigarette and e-cigarette use in the US (β = 0.57, β = 0.90) and Israel (β = 0.88, β = 0.92). IQOS use prevalence was low (US: 3.0%; Israel: 16.2%) but represented in vulnerable subpopulations (younger adults, racial/ethnic minorities).
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem 9112002, Israel
| | - Zongshuan Duan
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem 9112002, Israel
| | - Lorien C. Abroms
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem 9112002, Israel
| | - Sararat Tosakoon
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Katelyn F. Romm
- TSET Health Promotion Research Center, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Yan Wang
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Carla J. Berg
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
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23
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Wang Y, LoParco CR, Cui Y, Duan Z, Bar-Zeev Y, Levine H, Abroms LC, Khayat A, Berg CJ. Profiles of tobacco product use and related consumer characteristics in the US and Israel: A multiple-group latent class analysis. Glob Public Health 2023; 18:2267652. [PMID: 37885277 PMCID: PMC10683865 DOI: 10.1080/17441692.2023.2267652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023]
Abstract
Despite tobacco marketing diversification, limited research has examined use profiles across countries, particularly in relation to consumer values (e.g. appeal of innovation, conscientiousness). Using 2021 data, latent class analysis assessed past-month use of seven tobacco products (cigarettes, electronic cigarettes [e-cigarettes], heated tobacco products, cigars, hookah, pipe, smokeless) among adults reporting past-month use in the United States (US n = 382) and Israel (n = 561). Multivariable multinomial regression examined consumer values and sociodemographics in relation to country-specific class membership. US classes included: primarily cigarette 58.1%; e-cigarette-no cigarette 17.5%; primarily cigar 14.9%; and poly-product 9.9%. Higher innovation correlated with e-cigarette-no cigarette and poly-product (vs. primarily cigarette) use. Other correlates included being: younger with e-cigarette-no cigarette; male, Black, and more educated with primarily cigar; and Black and Asian (vs. White) with poly-product. Israel classes included: primarily cigarette 39.0%; moderate poly-product 40.3%; high poly-product 13.4%; and hookah 7.3%. Lower conscientiousness correlated with moderate poly-product (vs. primarily cigarette) use; higher innovation correlated with high poly-product; lower innovation correlated with hookah. Other correlates included being: younger, male, and more educated with moderate poly-product; male and sexual minority with high poly-product; and Arab with hookah. Tobacco consumer segments within and across countries likely reflect different consumer values and industry marketing targets.
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Affiliation(s)
- Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Cassidy R. LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
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24
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Duan Z, Wang Y, Romm KF, Henriksen L, Schleicher NC, Berg CJ. State T21, Restrictions on Flavored E-Cigarette Products, and Non-Medical Cannabis Sales Legalization in Relation to Young Adult Reports of Vape Shop Age Verification and Product Offerings: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15079. [PMID: 36429798 PMCID: PMC9690108 DOI: 10.3390/ijerph192215079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
Vape shop practices related to age verification and product offerings (e.g., other tobacco, cannabis), which may affect young-adult tobacco/substance use, are likely impacted by state-level policies (i.e., Tobacco 21 [T21], flavored e-cigarette restrictions, non-medical cannabis legalization). Using data from young adults (18-34 years) in 6 US states representing variability in whether/when they implemented the aforementioned policies, this study focused on past 6-month e-cigarette users who visited vape shops (Wave 1 [W1]: September-December 2018, n = 1127; W2: September-December 2019, n = 702; W3: September-December 2020, n = 549). Multilevel modeling examined T21 in relation to participants' reports of age verification at last vape shop visit (among those < 27), and flavor restrictions and cannabis legalization in relation to noticing other tobacco or cannabis products at last visit. At W1-W3, 69.7%, 78.7%, and 75.8% of participants < 27 reported age verification, and participants increasingly noticed other tobacco (W2: 36.9%; W3: 48.6%) and cannabis products (W1: 25.8%; W2: 41.3%; W3: 58.3%). State T21 was unrelated to age verification (aOR = 1.19, 95%CI = 0.80-1.79); flavored e-cigarette restrictions correlated with noticing other tobacco products (aOR = 1.96, 95%CI = 1.10-3.51); flavored e-cigarette restrictions (aOR = 2.26, 95%CI = 1.57-3.24) and cannabis legalization (aOR = 2.84, 95%CI = 1.78-4.51) correlated with noticing cannabis products. Regulatory efforts must be informed by ongoing surveillance of such policies and their impact.
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Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Katelyn F. Romm
- TSET Health Promotion Research Center, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Nina C. Schleicher
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
- George Washington Cancer Center, George Washington University, Washington, DC 20052, USA
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25
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Duan Z, Wysota CN, Romm KF, Levine H, Bar-Zeev Y, Choi K, Berg CJ. Correlates of Perceptions, Use, and Intention to Use Heated Tobacco Products Among US Young Adults in 2020. Nicotine Tob Res 2022; 24:1968-1977. [PMID: 35901840 PMCID: PMC9653079 DOI: 10.1093/ntr/ntac185] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Despite the increased heated tobacco product (HTP) marketing in the United States, little is known about HTP perceptions and correlates of HTP use and use intentions among young adults. AIMS AND METHODS Using 2020 cross-sectional data from 2,470 young adults (ages 18-34) from 6 US metropolitan areas, we conducted exploratory factor analysis to identify factors regarding perceived utility/appeal of HTPs, specifically IQOS, and examined these factors in relation to lifetime HTP use and use intentions, using multivariable logistic and linear regression, respectively. RESULTS 19.1% had heard of HTPs and 4.1% ever used HTPs; 14.7% had heard of IQOS specifically and 2.8% were ever-users. Use intentions were low (M = 1.27, scale: 1 = not at all to 7 = extremely). Factor analysis identified five perceived utility/appeal factors: innovation (M = 3.17, scale: 1 = not at all to 7 = extremely), cigarette substitute (M = 2.99), and youth appeal (M = 2.82), e-cigarette/nicotine substitute (M = 2.36), and fashionable (M = 2.04). Controlling for sociodemographics and other tobacco use, perceiving IQOS as more fashionable and e-cigarette substitutes positively correlated with lifetime HTP use (aOR = 1.60, 95%CI = 1.17, 2.17; aOR = 1.48, 95%CI = 1.11, 1.97, respectively) and use intentions (β = 0.26, 95%CI = 0.21, 0.30; β = 0.14, 95%CI = 0.09, 0.18); perceiving IQOS as cigarette substitutes negatively correlated with ever use (aOR = 0.74, 95%CI = 0.56, 0.97) and use intentions (β = -0.06, 95%CI = -0.10, -0.03). Correlation patterns were similar among past-month cigarette, e-cigarette, and any-tobacco users. CONCLUSIONS Although HTP awareness and use were low, monitoring HTP perceptions and reasons for use as HTPs become more prominent is critical in anticipating their potential impact, particularly as more products seek FDA authorization to use reduced risk or exposure marketing claims. IMPLICATIONS Awareness, ever use, and intentions to use heated tobacco products (HTPs) were low among US young adults in 2020. Perceiving IQOS as fashionable and an e-cigarette substitute were positively correlated with ever use and intention to use HTPs. In addition, perceiving IQOS as a cigarette substitute was negatively correlated with ever use of HTPs and HTP use intentions. Continued surveillance on perceptions and use behaviors is needed to better understand use patterns, intentions to use, and reasons for using HTPs.
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Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- George Washington Cancer Center, George Washington University, Washington, DC, USA
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Czaplicki L, Marynak K, Kelley D, Moran MB, Trigger S, Kennedy RD. Presence of Nicotine Warning Statement on US Electronic Nicotine Delivery Systems (ENDS) Advertisements 6 Months Before and After the August 10, 2018 Effective Date. Nicotine Tob Res 2022; 24:1720-1726. [PMID: 35486959 PMCID: PMC10546915 DOI: 10.1093/ntr/ntac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/22/2022] [Accepted: 05/10/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Effective in August 10, 2018, FDA requires advertisements for electronic nicotine delivery systems (ENDS) that meet the definition of a "covered tobacco product" to feature a standard nicotine warning statement. To date, limited data exist on the presence of warning statements in ENDS advertising. METHODS We acquired ENDS ads (n = 459) that first ran six months before (February 10, 2018-August 9, 2018) and after (August 10, 2018-February 9, 2019) the effective date. The sample included online, print, and outdoor static ads (ie, without video or animated graphics) (n = 166 before, n = 198 after), online and television video ads (n = 16 before, n = 49 after), and radio ads (n = 9 before, n = 21 after). We coded ads for the presence of the verbatim FDA warning. Ads with verbatim warnings were coded for required formatting and additional features. RESULTS Overall, 28% of static (n = 46/166), 62% of video (n = 10/16), and 67% of radio (n = 6/9) ads that ran before the effective date contained the verbatim warning versus 84% (n = 167/198, p < .001), 96% (n = 47/49, p = .002), and 86% (n = 18/21, p =.329) of ads that ran after, respectively. Following the effective date, nearly all static ads placed the warning as required at the top of the ad (76% [n = 35/46] before, 97% [n = 162/167] after, p < .001), and many video ads featured the warning statement for the entire ad duration (0% [n = 0/10] before, 60% [n = 28/47] after, p < .001). Half (n = 9/18) of radio warnings running after the effective date were read faster than the other promotional content. CONCLUSIONS The presence of the nicotine warning statement on paid promotional static, video, and radio ENDS ads in this sample increased after August 10, 2018, but a notable number still lacked the warning. IMPLICATIONS Results from this study provide initial insights into the extent to which required nicotine warning statements appear in ENDS ads in the study sample across traditional (eg, magazines, television, radio) and digital (eg, online/mobile ads) advertising mediums. Following the August 10, 2018, effective date, we observed a substantial increase in the presence of the required FDA warning statement on the ENDS ads in this sample. However, a notable number of ads in the study lacked the required warning and warnings did not always include the required formatting displays.
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Affiliation(s)
- Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kristy Marynak
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dannielle Kelley
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Meghan Bridgid Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Trigger
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Ryan David Kennedy
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Duan Z, Le D, Ciceron AC, Dickey-Chasins R, Wysota CN, Bar-Zeev Y, Levine H, Abroms LC, Romm KF, Berg CJ. 'It's like if a vape pen and a cigarette had a baby': a mixed methods study of perceptions and use of IQOS among US young adults. HEALTH EDUCATION RESEARCH 2022; 37:364-377. [PMID: 36036655 PMCID: PMC9502850 DOI: 10.1093/her/cyac019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
Young adults' perceptions and use of heated tobacco products (HTPs) are understudied. This mixed methods study analyzed (i) Fall 2020 survey data from 2470 US young adults (meanage = 24.67; 19.5% and 25.2% past-month cigarette and e-cigarette use; 4.1% ever HTP use) assessing HTP use intentions and perceptions (1 = not at all to 7 = extremely) and (ii) Spring 2021 interview data regarding IQOS (most widely available HTP) in a subset of 40 e-cigarette users. Among survey participants, HTPs versus cigarettes and e-cigarettes showed lower use intentions (mean = 1.27 vs. mean = 1.73, mean = 2.16) but were perceived as less addictive (mean = 5.11 vs. mean = 6.28, mean = 5.82) and harmful (mean = 5.37 vs. mean = 6.65, mean = 5.62). HTPs were perceived more socially acceptable than cigarettes but less than e-cigarettes (mean = 3.39 vs. mean = 3.13, mean = 4.37). Among interviewees, most reported limited HTP knowledge. A few perceived IQOS as a hybrid of traditional cigarettes and e-cigarettes. Most perceived IQOS as harmful but less harmful than cigarettes and were uncertain in relation to e-cigarettes. Over half reported minimal interest in trying IQOS; common reasons included IQOS containing tobacco, limited flavors and use complexity. The varied perceptions of IQOS versus cigarettes and e-cigarettes underscore the need for continued surveillance of perceptions, use and marketing of IQOS to inform regulatory oversight and potential interventions.
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Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Daisy Le
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, 1919 Pennsylvania Ave NW, Suite 500, Washington, DC 20052, USA
- George Washington Cancer Center, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Annie C Ciceron
- Department of Policy, Populations, and Systems, School of Nursing, George Washington University, 1919 Pennsylvania Ave NW, Suite 500, Washington, DC 20052, USA
| | - Ruth Dickey-Chasins
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, 4th Floor, Washington, DC 20052, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, PO Box 12272, Jerusalem 9110202, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, PO Box 12272, Jerusalem 9110202, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
- George Washington Cancer Center, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
- George Washington Cancer Center, George Washington University, 800 22nd St NW, #7000, Washington, DC 20052, USA
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Stone MD, DeAtley T, Pianin S, Strasser AA, Audrain-McGovern J. Switching from cigarettes to IQOS: A pilot examination of IQOS-associated reward, reinforcement, and abstinence relief. Drug Alcohol Depend 2022; 238:109569. [PMID: 35841732 DOI: 10.1016/j.drugalcdep.2022.109569] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND It is unknown whether IQOS-associated decreases in cigarette craving, nicotine withdrawal, greater subjective reward, and relative reinforcing value predict subsequent switching from cigarettes to IQOS products. METHODS Nontreatment-seeking adult daily smokers (n = 33; 18-65 years old) completed a within-subject pilot study consisting of a baseline ad-lib smoking period (days 1-5), two laboratory visits (days 6-7), and a two-week period where participants switch from using cigarettes to using IQOS (days 8-21). Mixed-effect modelling estimated the percentage of baseline cigarette consumption replaced by daily IQOS HeatSticks used. Predictors of use included IQOS-associated reinforcement, subjective reward, and craving and withdrawal relief. RESULTS IQOS use alleviated cigarette abstinence-associated craving (change=-14.22, p < .001) but did not alleviate withdrawal symptoms. Smokers initially substituted IQOS for 59% of their average daily cigarette consumption, increasing to 87% by switch period end (B=0.02 [95%CI=0.01, 0.03], p = .002). Neither subjective reward of IQOS nor relief of cigarette craving and withdrawal symptoms were predictive of this change. By study end, IQOS consumption was 124% of regular cigarette consumption among participants with a low reinforcing value of cigarettes relative to IQOS (β = 0.03 [95%CI=0.00, 0.06], p = .049). In contrast, participants with a higher reinforcing value of smoking replaced 76% of their cigarettes with IQOS. CONCLUSIONS IQOS shows potential as an alternative to combustible cigarettes. However, IQOS use may result in dual-use for most smokers and increase tobacco consumption among a subgroup of smokers. These preliminary findings highlight the need for a larger investigation of the relationship between IQOS use and cigarette smoking.
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Affiliation(s)
- Matthew D Stone
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Teresa DeAtley
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen Pianin
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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