Abstract
INTRODUCTIONTobacco companies have introduced heated tobacco products (HTPs), such as IQOS, which may compete with e-cigarettes among smokers interested in switching to potentially reduced-risk products. Non-smokers may also start using IQOS if they believe this product is less harmful than other nicotine products. Smokers’ and non-smokers’ decisions may be driven by relative harm perceptions of emerging nicotine products. We aimed to examine relative harm perceptions between IQOS, e-cigarettes, and cigarettes, among nicotine product users and non-users.METHODSWe conducted a web survey with Canadian respondents (aged ≥20 years; n=268) in September–October 2018. Perceptions about relative harm between IQOS (available for sale since 2017 and subject to the same comprehensive marketing restrictions as cigarettes in Canada), e-cigarettes, and cigarettes, were assessed among non-users (n=79), exclusive smokers (n=78), exclusive e-cigarette users (n=32), and dual users (n=79). Multiple logistic regression explored the association between relative harm perceptions and nicotine-use status, adjusting for sociodemographic variables.RESULTSOver half of respondents perceived IQOS as equally or more harmful than e-cigarettes (53.7%), while almost a quarter either reported IQOS as less harmful than e-cigarettes or were uncertain (22.7% and 23.5%, respectively). Two-thirds of respondents (65.7%) perceived e-cigarettes as less harmful than cigarettes, yet only half (48.1%) perceived IQOS as less harmful than cigarettes. Both exclusive and dual e-cigarette users, but not exclusive smokers, had higher odds of perceiving IQOS as more harmful than e-cigarettes and less harmful than cigarettes compared to non-users.CONCLUSIONSMost nicotine users and non-users perceive differential health risk across IQOS, e-cigarettes, and cigarettes. Although e-cigarettes are generally viewed as less harmful than cigarettes, the perceived harm of IQOS was unclear.
Highlights
Tobacco companies have introduced heated tobacco products (HTPs), such as IQOS, which may compete with e-cigarettes among smokers interested in switching to potentially reduced-risk products
Japanese participants were not included in this study as the sale of e-cigarettes is banned in Japan, the survey did not ask about e-cigarette harm perceptions to Japanese participants
More than one-third of respondents perceived IQOS to be as harmful as e-cigarettes (36.9%), almost a quarter either reported IQOS as less harmful or were uncertain (22.7% and 23.5%, respectively), while the rest perceived IQOS to be more harmful than e-cigarettes (16.8%)
Summary
Tobacco companies have introduced heated tobacco products (HTPs), such as IQOS, which may compete with e-cigarettes among smokers interested in switching to potentially reduced-risk products. We aimed to examine relative harm perceptions between IQOS, e-cigarettes, and cigarettes, among nicotine product users and non-users. Perceptions about relative harm between IQOS (available for sale since 2017 and subject to the same comprehensive marketing restrictions as cigarettes in Canada), e-cigarettes, and cigarettes, were assessed among non-users (n=79), exclusive smokers (n=78), exclusive e-cigarette users (n=32), and dual users (n=79). While many countries do not allow alternative nicotine products to be marketed as less harmful than cigarettes, there are often subtle messages about the potential risk reduction if smokers switched to e-cigarettes or HTPs. Lower harm perceptions toward certain nicotine products have been reported as a predictor of future use[1]. While many studies have examined harm perceptions of e-cigarettes relative to cigarettes[2,3], only a handful have evaluated HTPs relative to cigarettes[4,5,6], and none has assessed HTPs relative to e-cigarettes
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