Abstract
The heated tobacco product (HTP) IQOS was authorized for sale in the US in 2019. We investigated how young adults with experience using multiple tobacco products reacted to, perceived, and developed interest in IQOS, informing policies that might prevent HTPs from becoming ubiquitous. We used a novel qualitative method in which 33 young adult tobacco users in California (fall 2019) “unboxed” an IQOS device, tobacco sticks, and marketing materials and narrated their impressions and opinions. We conducted content and thematic analyses of participants’ reactions, sensory experiences, and interest. Multiple attributes influenced appeal for participants, including sleek electronic design, novel technology, perceived harmfulness, complexity, and high cost. The “no smoke” claim and heating technology suggested that smoking IQOS was safer than smoking cigarettes. Public health programs should closely monitor HTP marketing and uptake, particularly as “reduced exposure” claims were authorized in July 2020. Evidence-based regulations (e.g., requiring plain packaging for tobacco sticks), actions addressing IQOS’ unique attributes (e.g., regulating device packaging to reduce high-tech appeal), and public education might help to counter the appeal generated by potentially misleading IQOS marketing tactics.
Highlights
Novel tobacco products such as e-cigarettes and heated tobacco products (HTPs) might undermine decades of tobacco control efforts in the United States that have shifted social norms, decreased smoking prevalence, and reduced tobacco-related morbidity and mortality [1] if they recruit young people or deter smoking cessation
In the US, the e-cigarette market has rapidly evolved into sleek, easy-to-use, and concealable “pod-vapes”, and e-cigarette use among youth has risen to epidemic levels [2]
While the “continuum of risk” promoted by tobacco companies classifies HTPs as higher risk than e-cigarettes [29,30], several participants thought smoking IQOS might be less harmful than using e-cigarettes because of e-cigarette or vaping product use-associated lung injury (EVALI)
Summary
Novel tobacco products such as e-cigarettes and heated tobacco products (HTPs) might undermine decades of tobacco control efforts in the United States that have shifted social norms, decreased smoking prevalence, and reduced tobacco-related morbidity and mortality [1] if they recruit young people or deter smoking cessation. In 2019, almost five times as many US high schoolers reported using e-cigarettes (27.5%) than using cigarettes (5.8%) [2] and, despite growing evidence of associated health risks [3], e-cigarettes are commonly accepted in otherwise tobacco-free environments [4]. In October 2019, with authorization from the US Food and Drug Administration (FDA) [5], Philip Morris International (PMI) introduced a new HTP into the US market—IQOS. Res. Public Health 2020, 17, 8108; doi:10.3390/ijerph17218108 www.mdpi.com/journal/ijerph
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