1
|
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:cyae018. [PMID: 38739472 DOI: 10.1093/her/cyae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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.
Collapse
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
| |
Collapse
|
2
|
Noh MAM, Hairi FM, Nordin ASA, Yee A, Tajuddin NAA, Hasan SI, Danaee M, Kamaludin IS, Subramaniyan M, Pravinassh R, Kaai SC, Driezen P, Yan M, Xu SS, Quah ACK, Fong GT. Prevalence and reasons for use of heated tobacco products among Malaysian adults who smoked: Findings from the 2020 International Tobacco Control Malaysia Survey. Drug Alcohol Depend 2024; 257:111131. [PMID: 38428371 DOI: 10.1016/j.drugalcdep.2024.111131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION There have been rapid expansions in heated tobacco products (HTPs) outside of Japan and the Republic of Korea. In November 2018, HTPs were first introduced in Malaysia and since then, no studies have been conducted on Malaysians' use of HTPs. This study is the first to examine the prevalence of HTP use and reasons for use among Malaysian adults who smoked cigarettes. METHODS Data came from the 2020 ITC Malaysia Survey, a web-based survey of a nationally representative sample of adults who smoked (n=1047) aged 18 and older. They were asked on ever heard of, ever used, and currently using HTPs, and their reasons for using HTPs. RESULTS Overall, 25.4% (n= 324; 95% CI:22.3%-28.7%) of Malaysians who smoked reported ever used HTPs with 6.7% (n=85; 95% CI:22.3%-28.7%) were using them daily and 8.1% (n=110; 95% CI:6.4% -10.2%) were using HTPs non-daily. Most of them (57.2%) who dual use were of aged 25-39 and 97.3% were males. Among those who smoked daily, almost half (49.3%) were also using HTP daily. Among those who used HTPs daily and non-daily, curiosity (84.2%, 95% CI:78.4%-90.0%), taste (83.2%, 95% CI:77.3%-89.1%), and appealing technology (78.5%, 95% CI:71.3%-85.6%) were the most reported reasons. Among those who used HTPs daily, curiosity was the top reason (87.9%, 95% CI:78.9%-93.4%), while among non-daily, taste good was the top reason (81.9%, 95% CI:71.9%-88.8%). CONCLUSIONS The very high use of HTPs among Malaysians who smoked requires continued public health surveillance that can inform the regulation of these novel tobacco products.
Collapse
Affiliation(s)
- Muhamad Alfakri Mat Noh
- Department of Anatomy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia.
| | - Farizah Mohd Hairi
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne Yee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Amani Ahmad Tajuddin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Idayu Hasan
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danaee
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ina Sharyn Kamaludin
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Muniswary Subramaniyan
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Pravinassh
- Nicotine Addiction Research Group, University of Malaya Centre of Addiction Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Susan C Kaai
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Steve S Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Odani S, Koyama S, Miyashiro I, Tanigami H, Ohashi Y, Tabuchi T. Association between heated tobacco product use and airway obstruction: a single-centre observational study, Japan. BMJ Open Respir Res 2024; 11:e001793. [PMID: 38460973 DOI: 10.1136/bmjresp-2023-001793] [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: 04/25/2023] [Accepted: 02/07/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND While heated tobacco products (HTPs) may affect pulmonary function, the evidence supporting the utility of screening for HTP use in clinical settings is insufficient. We examined the association between HTP use and airway obstruction after switching from cigarettes. METHOD The study subjects were patients aged ≥20 years undergoing surgery from December 2021 to September 2022 who completed spirometry and reported tobacco (cigarette and HTP) use status during the preoperative assessment. Airway obstruction was defined as forced expiratory volume in 1 s to forced vital capacity ratio below the lower limit of normal. Current tobacco use was defined as past-30-day use. Multivariable Poisson regression analysis was performed to examine the associations between HTP use and airway obstruction by adjusting for demographic characteristics, lifetime cigarette smoking (pack-year) and duration of smoking cessation. RESULTS Overall (N=2850, 55.4% women, mean age 62.4), 4.6% and 10.7% reported current HTP use and cigarette smoking, respectively. 16.8% had airway obstruction. Airway obstruction was more common among current HTP-only users (adjusted prevalence ratio (APR)=2.32), current cigarette-only smokers (APR=2.57) and current dual users (APR=2.82) than never-tobacco users. Among current tobacco users (N=398), the prevalence of airway obstruction was not significantly different between HTP-only users and cigarette-only smokers. Among former cigarette smokers (>30-day cigarette quitters) (N=1077), current HTP users had 1.42 times the increased prevalence of airway obstruction than never-HTP users after adjusting for cigarette pack-year; a stronger association was observed when the analysis was restricted to ≥5-year cigarette quitters (N=772) (APR=1.96, vs never HTP users). CONCLUSION Current HTP use was associated with airway obstruction among patients with cancer who had completely switched from cigarettes even after quitting smoking for a long period. Patients should be routinely screened for HTP use and advised to quit any tobacco.
Collapse
Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
| | - Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Hironobu Tanigami
- Division of Anesthesiology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshifumi Ohashi
- Division of Anesthesiology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
| |
Collapse
|
5
|
Duan Z, Henriksen L, Vallone D, Rath JM, Evans WD, Romm KF, Wysota C, Berg CJ. Nicotine pouch marketing strategies in the USA: an analysis of Zyn, On! and Velo. Tob Control 2024; 33:154-163. [PMID: 35817549 DOI: 10.1136/tc-2022-057360] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/27/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Nicotine pouches are gaining popularity, yet their marketing is understudied. METHODS Using Numerator advertising data from January 2019 to September 2021 regarding three popular brands of nicotine pouch in the USA-Zyn (by Swedish Match, introduced in the USA in July 2016), On! (Altria, August 2016) and Velo (RJ Reynolds, July 2019)-we examined (1) general advertising characteristics (eg, media type, year); (2) ad content (ie, headlines and imagery themes); (3) prominent media channels (ie, specific websites, magazines, etc); and (4) ad expenditures. RESULTS There were 286 unique ads (Zyn: 44.4%; On!: 2.8%; Velo: 52.8%), 119 143 occurrences (Zyn: 3.5%; On!: 0.5%; Velo: 96.0%) and $24 774 650 total expenditures (Zyn: 4.7%; On!: 0.6%; Velo: 94.7%). The greatest proportion of ad occurrences and expenditures were accounted for by radio (75.9% and 28.2%, respectively) and television (16.2% and 56.5%), followed by mobile (0.5% and 7.2%) and online display (6.7% and 3.6%). Across ad occurrences and expenditures, prominent headline themes included 'freedom' (26.0% and 17.1%, respectively), 'brand' (9.6% and 18.6%) and 'flavour' (16.4% and 7.6%); images mainly featured the product alone (61.4% and 56.1%), text (16.2% and 24.6%) or men (8.7% and 8.6%); and prominent channel themes were entertainment (34.7% and 37.3%), news/weather (14.3% and 21.7%), business/finance (12.9% and 9.0%) and sports (9.5% and 1.0%). Zyn and On! prioritised online display and print; Velo prioritised radio and television. Zyn's and Velo's headlines focused on 'freedom', with Zyn also emphasising 'brand' and Velo 'innovation'; On!'s headlines emphasised 'flavour'. CONCLUSIONS Regulatory efforts must be informed by surveillance of nicotine pouch marketing and impacts on consumer subgroups (eg, young people).
Collapse
Affiliation(s)
- Zongshuan Duan
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - Donna Vallone
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
- School of Global Public Health, New York University, New York, New York, USA
| | - Jessica M Rath
- Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - W Douglas Evans
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Christina Wysota
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Carla J Berg
- Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| |
Collapse
|
6
|
Sharma A, Fix B, Hyland A, Bansal-Travers M, Quisenberry A, O’Connor R. Exposure to IQOS ads and reduced exposure claims, and association with perceived risk from COVID-19 on IQOS purchase and use intentions: results from a web-based survey. Front Public Health 2024; 11:1307484. [PMID: 38269390 PMCID: PMC10805831 DOI: 10.3389/fpubh.2023.1307484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/22/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction IQOS was authorized to be marketed as a reduced exposure product by the Food and Drug Administration in October 2020 during the global COVID-19 pandemic. Those who smoke may be more sensitive to reduced exposure marketing claims and may have an increased inclination toward IQOS use. We evaluated the likelihood of trying and purchasing IQOS as a function of exposure to ads, product appeal, and COVID-19 risk perceptions using the original IQOS ads with reduced exposure marketing. Method An online cross-sectional survey recruited 604 US adults (18-45 years), both who smoke and do not smoke. Participants saw one of the six randomly assigned IQOS ads with or without reduced exposure claims, and they answered questions about product appeal and likelihood to try and purchase IQOS. Generalized linear models were used to examine associations. Results A per unit increase in product appeal was associated with a greater likelihood of purchasing (B = 0.17, 95% CI: 0.15-0.18) and trying IQOS (B = 0.16, 95% CI = 0.14-0.18). Current smokers and former e-cigarette users reported greater intentions to try IQOS than never-smokers and never e-cigarette users, respectively. Likelihood to purchase IQOS was associated with greater confidence in not contracting COVID-19 (B = 0.11, 95% CI: 0.01-0.21). No significant differences were observed between different ad conditions. Current (B = -0.34, 95% CI = -0.50-(-0.19)) and former (B = -0.92, 95% CI = -0.15-(-0.68)) cigarette smokers who were someday e-cigarette users reported less intentions to purchase IQOS than never e-cigarette users. However, never smokers who were someday (B = 0.58, 95% CI = 0.27-0.89; B = 0.68, 95% CI = 0.39-0.98) and former e-cigarette (B = 0.38, 95% CI = 0.15-0.61) users reported greater intentions to purchase and try IQOS, respectively. Discussion IQOS may have a higher product appeal, especially for those who currently smoke and those who have lower risk perceptions from COVID-19. Among never smokers, those who currently use or have used e-cigarettes in the past may be more receptive to IQOS marketing. The data are informative for potential trends in the use of IQOS in the future and may have implications for marketing regulations of heated tobacco products (HTPs).
Collapse
Affiliation(s)
- Akshika Sharma
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Brian Fix
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Amanda Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Richard O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| |
Collapse
|
7
|
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:JE20230177. [PMID: 38191179 DOI: 10.2188/jea.je20230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
IntroductionIn 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 identify the explanatory factors associated with the perception of HTP as less harmful than conventional cigarettes.MethodsA 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 (e.g., individual characteristics, socioeconomic status, and trusted sources of cancer information) and the perception of HTPs as less harmful.ResultsAmong 3,420 participants (response rate: 35.2%), 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 proportion were 49.9% and 30.4%, respectively. Among 1,160 non-tobacco users who were familiar with HTPs, male, aged under 39 years, and had 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.ConclusionsThis study showed that, among non-tobacco users, being male, aged under 39 years, and 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 non-tobacco users.
Collapse
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
| |
Collapse
|
8
|
Nowicka J, Balwicki L. Heated tobacco products and cigarette marketing in nightclubs in Gdansk, Poland: A mixed-methods analysis. Tob Prev Cessat 2024; 10:TPC-10-01. [PMID: 38188060 PMCID: PMC10768186 DOI: 10.18332/tpc/174573] [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: 08/29/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Although advertising and promotion of tobacco products in Poland are prohibited, tobacco companies exploit legal loopholes and insufficient enforcement of the laws to conduct their marketing. To reach young adults, advertisements are placed in entertainment and social venues. This aspect of tobacco product marketing in Poland remains under-researched. The main aim of this study was to investigate the occurrence and characteristics of advertising and promotion of tobacco products in nightclubs in Gdansk, a large city in northern Poland. METHODS We conducted a single-center observational study of nightclubs in Gdansk, between July and October 2022. Two independent observers visited 30 nightclubs and collected information using pre-prepared research form. The occurrences of tobacco branded bar accessories, logo signs, package displays and other forms of advertising and promotion were recorded. Where possible, photographs of visible marketing displays were taken. RESULTS Advertising of tobacco products was present in 2/3 of the nightclubs observed. The most commonly advertised product category were heated tobacco products. Tobacco brand representatives promoted and offered consumers free tobacco product samples. Multi-level marketing activities were observed, including tobacco branded bar accessories, prominent sale points and tobacco brand logo signs. CONCLUSIONS The majority of nightclubs observed in Gdansk advertise and promote tobacco products. The ban on tobacco advertising and promotion is being violated in nightclubs, where the most commonly advertised products are heated tobacco products. The authorities should take steps to extend the bans to cover private promotion and enforce the law to protect high-risk individuals from smoking initiation and relapse.
Collapse
Affiliation(s)
- Julia Nowicka
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Lukasz Balwicki
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
9
|
Monzon J, Mus S, Davila G, Barnoya J, Kim M, Thrasher J. Lil Solid: a more affordable option for heated tobacco products in Guatemala. Tob Control 2023:tc-2023-057954. [PMID: 38050166 PMCID: PMC11109015 DOI: 10.1136/tc-2023-057954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Jose Monzon
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
- Health Sciences School, Rafael Landivar University, Guatemala City, Guatemala, Guatemala
| | - Sophia Mus
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Gustavo Davila
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Joaquin Barnoya
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - James Thrasher
- Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| |
Collapse
|
10
|
Otsuka Y, Kaneita Y, Itani O, Matsumoto Y, Hatori Y, Imamura S. Awareness, Attitudes, and Concerns Regarding Heated Tobacco Products Among Physicians in Japan. J Epidemiol 2023; 33:441-449. [PMID: 35370227 PMCID: PMC10409525 DOI: 10.2188/jea.je20210470] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/13/2022] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND New tobacco products, particularly heated tobacco products (HTPs), have been introduced across several international markets as alternatives to combustible products, such as cigarettes. However, there are limited studies on physicians' perceptions of HTPs. This study analyzes the awareness of HTPs among physicians and assesses their concerns and attitudes toward patients using HTPs. METHODS A self-administered questionnaire was sent to a sample of 7,500 member physicians (6,000 male and 1,500 female) from the Japan Medical Association (JMA). The smoking status of physicians was categorized as never smokers, ever HTP smokers, current HTP smokers, and ever and current smokers of other products. Physicians' awareness and attitudes toward patients using HTPs were analyzed using descriptive statistics. The correlation between the outcomes was examined using logistic regression models, whereas physicians' concerns about HTPs were analyzed using descriptive statistics. RESULTS Data were obtained from 5,492 physicians (21.9% women; aged 60.4; standard deviation, 12.1 years) with a response rate of 74.6%. Overall, 76.7% of the physicians had awareness of HTP, and about half of whom asked patients about using HTPs. Physicians who took longer to discuss cessation were more likely to discourage patient use. Smoking status was associated with discouraging HTP use in patients. Physicians who had experience with HTP use were primarily concerned about the products' long-term safety and less about product regulation. CONCLUSION Japanese physicians do not have sufficient information and knowledge about HTPs. Therefore, evidence-based guidelines are required to support physicians in advising patients against HTP use.
Collapse
Affiliation(s)
- Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuuki Matsumoto
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | | | | |
Collapse
|
11
|
Henderson KC, Van Do V, Wang Y, Duan Z, Popova L, Spears CA, Weaver SR, Ashley DL, Barker DC, Huang J. Brief report on IQOS point-of-sale marketing, promotion and pricing in IQOS retail partner stores in Atlanta, Georgia, USA. Tob Control 2023; 32:e260-e264. [PMID: 35918133 PMCID: PMC9923501 DOI: 10.1136/tc-2022-057285] [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: 01/20/2022] [Accepted: 07/16/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Philip Morris has a history of aggressive marketing tactics in its global pursuit of IQOS sales, which extant literature suggests may appeal to non-smokers and young adults. This study was the first to examine point-of-sale (POS) marketing and pricing of IQOS after it entered the US market in October 2019. METHODS Trained field staff assessed 75 retail partner stores selling IQOS/HeatSticks in the Atlanta area in February-November 2020 using an IQOS-tailored, standardised assessment tool. The tool assessed store characteristics, product availability and accessibility, marketing and promotions and pricing for each store. RESULTS All stores assessed sold HeatSticks in at least one of the three flavours (tobacco, smooth menthol, fresh menthol), but did not sell the IQOS device. IQOS/HeatSticks marketing was present inside 98.5% and outside 17.3% of stores assessed. Marketing for other tobacco products was present inside 98.5% and outside 32% of stores. The average price per HeatSticks pack was US$6.40 compared with US$6.08 for Marlboro Red cigarettes. CONCLUSION Our study revealed a considerable amount of POS marketing and promotion for IQOS/HeatSticks at retail partner locations, visible to all retail consumers, including youth and non-smokers. This study was the first to examine IQOS POS marketing and promotion in the US context and findings add to the extant literature on IQOS global marketing strategies. As additional novel tobacco/nicotine products continue to enter the market, targeted monitoring of the POS marketing and promotion for these new products is warranted.
Collapse
Affiliation(s)
- Katherine C Henderson
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Vuong Van Do
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Yu Wang
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, School of Public Health, The George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Lucy Popova
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Claire Adams Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Scott R Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - David L Ashley
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Dianne C Barker
- Barker Bi-Coastal Health Consultant, Inc, Newport, Rhode Island, USA
| | - Jidong Huang
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| |
Collapse
|
12
|
Berg CJ, Romm KF, Bar-Zeev Y, Abroms LC, Klinkhammer K, Wysota CN, Khayat A, Broniatowski DA, Levine H. IQOS marketing strategies in the USA before and after US FDA modified risk tobacco product authorisation. Tob Control 2023; 32:418-427. [PMID: 34667105 PMCID: PMC9016087 DOI: 10.1136/tobaccocontrol-2021-056819] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Given that the US Food and Drug Administration (FDA) authorised reduced exposure messaging to be used in IQOS marketing, we examined: (1) IQOS ad content; (2) advertising media channels and (3) changes in advertising efforts over time. METHODS We conducted a mixed-methods study regarding IQOS ad content (headlines, themes, images), ad occurrence characteristics (including content, media channels and adspend) in the USA from August 2019 to April 2021 using Numerator advertising/marketing data. RESULTS Across 24 unique ads and 591 occurrences (84.6% online, 8.0% print, 7.4% mobile), there was $4 902 110 total adspend (98.9% allocated to print). Across unique ads, occurrences and adspend, prominent themes included 'real tobacco' (45.8%, 47.4%, 30.1%, respectively), less odour/ash (29.2%, 21.0%, 29.9%) and switching from cigarettes (25.0%, 19.5%, 69.4%), and images mainly featured the product alone (58.2%, 61.4%, 99.5%) or with women (25.0%, 19.1%, 0.3%). Per occurrences and adspend, the most prominent media channel themes (eg, magazine/website topics) were technology (19.3%, 10.6%), women's fashion (18.1%, 26.2%), weather/news (9.0%, 15.3%) and entertainment/pop culture/gaming (8.5%, 23.1%). Ad themes appearing only post-FDA authorisation included switching from traditional cigarettes, same-day/home-delivery, convenience (eg, use indoors), reduced exposure to some dangerous substances, science/research and distinction from e-cigarettes. Overall adspend per occurrence increased postauthorisation (p=0.016); the highest adspend per unique ad (69.3% of total) focused on ads featuring reduced exposure. CONCLUSIONS Regulatory efforts must be informed by ongoing surveillance of IQOS marketing efforts and its impacts, particularly how specific consumer subgroups (eg, tobacco non-users, women, young people) are impacted by marketing exposure.
Collapse
Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- GW Cancer Center, The George Washington University, Washington, DC, USA
| | - Katelyn F Romm
- 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, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
- GW Cancer Center, The George Washington University, Washington, DC, USA
| | - Katharina Klinkhammer
- Department of Prevention and Community Health, Milken Institute School of Public 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
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| | - David A Broniatowski
- Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Romanian young adult perceptions on using heated tobacco products following exposure to direct marketing methods. NPJ Prim Care Respir Med 2023; 33:8. [PMID: 36864067 PMCID: PMC9981255 DOI: 10.1038/s41533-023-00333-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023] Open
Abstract
Heated tobacco products have a rapid uptake, especially among young people, mostly where advertising is unregulated, as is the case in Romania. This qualitative study explores the influence of direct marketing methods of heated tobacco products on young people, their perception and behaviour towards smoking. We have carried out 19 interviews with smokers of heated tobacco products (HTPs) or/and combustible cigarettes (CCs) or non-smokers (NS), aged 18-26. Using the thematic analysis, we have identified three overarching themes: (1) people, places, and subjects of marketing, (2) engagement with risk narratives and (3) social body, family bonds, and autonomous self. Even if most of the participants have been exposed to a mix of marketing methods, they did not acknowledge the influence that marketing has on their decision to experience smoking. Young adults' decision to use heated tobacco products seems to be influenced by a cluster of reasons: overcoming the legislation gap which prohibits indoor use of combustible cigarettes but not heated tobacco products; the attractivity of the product (novelty, inviting appearance, technological appeal and price) and presumed less damaging effects on health.
Collapse
|
15
|
Mugharbil S, Tleis M, Romani M, Salloum RG, Nakkash R. Understanding Determinants of Electronic Cigarette and Heated Tobacco Product Use among Young Adults in Lebanon: Prevention and Policy Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4273. [PMID: 36901283 PMCID: PMC10001978 DOI: 10.3390/ijerph20054273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
In line with the global trends, electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) have found their way to the Lebanese market. The present study aims to explore the determinants of e-cigarette and HTP use among young adults in Lebanon. Convenience and snowball sampling were used to recruit participants aged 18-30 residing in Lebanon, who were familiar with e-cigarettes products. Twenty-one consenting participants were interviewed via Zoom and the verbatim transcriptions were analyzed thematically. The outcome expectancy theory was used to categorize the results into determinants and deterrents of use. HTPs were viewed by participants as another mode of smoking. The results showed that most participants perceived e-cigarettes and HTPs to be healthier alternatives to cigarettes/waterpipes and to be used as smoking cessation tools. Both e-cigarettes and HTPs were found to be easily accessible in Lebanon; although, in the recent economic crisis, e-cigarettes have become unaffordable. More research is needed to investigate the motivations and behaviors of e-cigarette and HTP users if effective policies and regulations are to be developed and enforced. Furthermore, greater public health efforts need to be made to increase awareness of the harmful impacts of e-cigarettes and HTPs and to implement evidence-based cessation programs tailored to those modes of smoking.
Collapse
Affiliation(s)
- Sanaa Mugharbil
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Malak Tleis
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon
| | - Maya Romani
- Department of Family Medicine, Faculty of Medicine, American University of Beirut Medical Center, Beirut 11-0236, Lebanon
| | - Ramzi G. Salloum
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Rima Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut 11-0236, Lebanon
- Global and Community Health Department, College of Public Health, George Mason University, Fairfax, VA 22030, USA
| |
Collapse
|
16
|
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).
Collapse
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
| |
Collapse
|
17
|
Sparrock LS, Phan L, Chen-Sankey J, Hacker K, Ajith A, Jewett B, Choi K. Heated Tobacco Products: Awareness, Beliefs, Use and Susceptibility among US Adult Current Tobacco Users, 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2016. [PMID: 36767383 PMCID: PMC9915028 DOI: 10.3390/ijerph20032016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 05/31/2023]
Abstract
Limited data exist on the awareness, beliefs, and use of heated tobacco products (HTPs). Data from 1583 U.S. adult (age ≥ 21 years) current tobacco users were collected in 2021. Participants self-reported HTP awareness, beliefs, use, and susceptibility, as well as current tobacco product use and sociodemographics. We used weighted logistic and multinomial regression models to explore their associations. Overall, 23.6% were aware of, 8.9% had ever used, and 3.0% currently used HTPs. Younger individuals (vs. 61+ years), those with annual income $50,000+ (vs. <$50,000), and those currently using electronic vaping products (vs. non-users) were more likely to be aware of, to have ever used, and to currently be using HTPs (p < 0.05). Black individuals (vs. White) were more likely to report ever and current HTP use (p < 0.05). Current cigarette smoking was not associated with HTP awareness and use (p > 0.05). Holding favorable HTP beliefs was associated with susceptibility to and more advanced HTP use statuses (p < 0.05). Sociodemographics associated with HTP use may reflect HTP marketing strategies. The lack of association with cigarette smoking suggests HTPs may be unlikely cigarette substitutes. Addressing favorable HTP-related beliefs may prevent dual use.
Collapse
Affiliation(s)
| | - Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, NJ 08854, USA
| | - Kiana Hacker
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Aniruddh Ajith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| |
Collapse
|
18
|
Odani S, Tabuchi T. Prevalence and denial of current tobacco product use: Combustible and heated tobacco products, Japan, 2022. Prev Med Rep 2022; 30:102031. [DOI: 10.1016/j.pmedr.2022.102031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022] Open
|
19
|
Zhu S, Zhang F, Zhao G, Zhang X, Zhang X, Li T, Hu C, Zhu W, Li D. Trends in the global burden of oral cancer joint with attributable risk factors: Results from the global burden of disease study 2019. Oral Oncol 2022; 134:106189. [DOI: 10.1016/j.oraloncology.2022.106189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/27/2022] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
|
20
|
Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
Collapse
Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
| |
Collapse
|
21
|
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: 0] [Impact Index Per Article: 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.
Collapse
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
| |
Collapse
|
22
|
Hosokawa Y, Zaitsu M, Okawa S, Morisaki N, Hori A, Nishihama Y, Nakayama SF, Fujiwara T, Hamada H, Satoh T, Tabuchi T. Association between Heated Tobacco Product Use during Pregnancy and Fetal Growth in Japan: A Nationwide Web-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11826. [PMID: 36142098 PMCID: PMC9517232 DOI: 10.3390/ijerph191811826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Combustible cigarette smoking impacts fetal growth during pregnancy. However, the risk associated with heated tobacco products (HTPs) remains unclear. This nationwide cross-sectional study investigated whether HTP use during pregnancy is associated with small for gestational age (SGA) outcomes among 5647 post-delivery women with singleton pregnancies, which were divided into four groups: lifetime never-smokers, former smokers before pregnancy, and current smokers for each of the tobacco products during pregnancy (sole HTP and sole combustion smokers). Information on the prevalence of SGA, defined as birth weight and height below the 10th percentile, was retrieved from the Maternal and Child Health Handbooks of post-delivery women. Using logistic regression, the association between sole HTP smokers during pregnancy and SGA, adjusted for covariates, with lifetime never-smokers as reference, was investigated. The prevalence was: current sole HTP smokers during pregnancy, 1.8% (102/5647); and SGA, 2.9% (164/5647). Sole HTP smokers during pregnancy had a higher prevalence of SGA (5.9% [6/102] vs. 2.7% [111/4144]) with an adjusted odds ratio (OR) of 2.50 (95% confidence interval [CI], 1.03-6.05) than lifetime never-smokers. Among sole combustion smokers, the adjusted OR for SGA was 1.95 (95% CI, 0.81-4.67). In Japan, HTP smoking during pregnancy may be associated with an increased risk for SGA.
Collapse
Affiliation(s)
- Yoshihiko Hosokawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Masayoshi Zaitsu
- Center for Research of the Aging Workforce, University of Occupational and Environmental Health, Kitakyushu 807-8556, Japan
| | - Sumiyo Okawa
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo 157-8535, Japan
| | - Ai Hori
- Department of Global Public Health, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Yukiko Nishihama
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Tsukuba 305-8506, Japan
| | - Shoji F. Nakayama
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Tsukuba 305-8506, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Hiromi Hamada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Toyomi Satoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan
| |
Collapse
|
23
|
Crosbie E, Hartman J, Tran B, Bialous S. Promoting healthier options? Inside the branding of light cigarettes and targeting youth in Brazil. Glob Public Health 2022; 17:1913-1923. [PMID: 34852728 DOI: 10.1080/17441692.2021.2003840] [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: 05/16/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022]
Abstract
This study aimed to understand how the internal strategies of British American Tobacco (BAT) selling 'light' cigarettes to young people in Brazil may inform current global efforts to promote new tobacco and nicotine products. We reviewed industry documents in the Truth Tobacco Industry Documents (TTID) Library. In 1976, Philip Morris and BAT introduced 'low tar' or 'light' cigarettes in Brazil to maintain and attract new young smokers. At the time it was a novel tobacco product that implied lower health risks. While an initial push for 'light' cigarettes in Brazil did not materialise in the 1970s, BAT launched a new 'light' cigarette, Free, in 1984, with a marketing campaign consisting of symbols of personal freedom and choice to attract young people. In the mid-1990s, BAT used the success in Brazil to expand the lights segment throughout Latin America. BAT drove the lights segment through brand marketing and claims of a healthier alternative. As tobacco companies introduce and market new tobacco and nicotine products, mixing health and imagery messages, governments should recognise aggressive brand marketing messaging to attract new tobacco users and ensure that marketing regulations are enforced.
Collapse
Affiliation(s)
- Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, NV, USA
- Ozmen Institute for Global Studies, University of Nevada Reno, Reno, NV, USA
| | - Johnny Hartman
- School of Public Health, University of Nevada Reno, Reno, NV, USA
| | - Brian Tran
- School of Public Health, University of Nevada Reno, Reno, NV, USA
| | - Stella Bialous
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
24
|
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] [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.
Collapse
Affiliation(s)
- Zongshuan Duan
- Corresponding Author: Zongshuan Duan, PhD, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Science & Engineering Hall, 800 22nd St NW, #7000, Washington, DC 20052, USA. Telephone: 706-572-9100; E-mail:
| | - 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
| |
Collapse
|
25
|
Silver NA, Kierstead EC, Briggs J, Schillo B. Charming e-cigarette users with distorted science: a survey examining social media platform use, nicotine-related misinformation and attitudes towards the tobacco industry. BMJ Open 2022; 12:e057027. [PMID: 35649587 PMCID: PMC9160585 DOI: 10.1136/bmjopen-2021-057027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/15/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine the role of social media in promoting recall and belief of distorted science about nicotine and COVID-19 and whether recall and belief predict tobacco industry beliefs. DESIGN Young adults aged 18-34 years (N=1225) were surveyed cross-sectionally via online Qualtrics panel. The survey assessed recall and belief in three claims about nicotine and COVID-19 and three about nicotine in general followed by assessments of industry beliefs and use of social media. Ordinal logistic regression with robust standard errors controlling for gender, race/ethnicity, education, current e-cigarette use and age was used to examine relationships between variables. RESULTS Twitter use was associated with higher odds of recall (OR=1.21, 95% CI=1.01 to 1.44) and belief (OR=1.26, 95% CI=1.04 to 1.52) in COVID-19-specific distorted science. YouTube use was associated with higher odds of believing COVID-19-specific distorted science (OR=1.32, 95% CI=1.09 to 1.60). Reddit use was associated with lower odds of believing COVID-19-specific distorted science (OR=0.72, 95% CI=0.59 to 0.88). Recall (OR=1.26, 95% CI=1.07 to 1.47) and belief (OR=1.28, 95% CI=1.09 to 1.50) in distorted science about nicotine in general as well as belief in distorted science specific to COVID-19 (OR=1.61, 95% CI=1.34 to 1.95) were associated with more positive beliefs about the tobacco industry. Belief in distorted science about nicotine in general was also associated with more negative beliefs about the tobacco industry (OR=1.18, 95% CI=1.02 to 1.35). CONCLUSIONS Use of social media platforms may help to both spread and dispel distorted science about nicotine. Addressing distorted science about nicotine is important, as it appears to be associated with more favourable views of the tobacco industry which may erode public support for effective regulation.
Collapse
Affiliation(s)
- Nathan A Silver
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Elexis C Kierstead
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Jodie Briggs
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| | - Barbara Schillo
- Schroeder Institute, Truth Initiative, Washington, District of Columbia, USA
| |
Collapse
|
26
|
Havermans A, van Nierop LE, Pauwels CGGM, Talhout R. “It’s Like Jogging Next to the Highway”: A Qualitative Analysis of the Motivations and Experiences of Single-, Dual-, and Ex-Users of IQOS in The Netherlands. TOXICS 2022; 10:toxics10060283. [PMID: 35736892 PMCID: PMC9229017 DOI: 10.3390/toxics10060283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023]
Abstract
The popularity of heated tobacco products (HTPs) is of concern, as most users are dual users exposed to emissions of both HTPs and conventional cigarettes. Furthermore, HTPs may appeal to young people and non-smokers. This study aims to build intelligence on user experiences in order to inform policy development. We conducted five semi-structured focus group interviews with single-, dual-, and ex-users of the HTP IQOS. The discussions focused on initiation and use, experiences and perception, and knowledge and information needs. We performed a thematic analysis of the transcripts. All users smoked cigarettes and/or roll your own (RYO) tobacco before using HTP. We found that almost all users started using IQOS after being introduced to it by others. Single users successfully quit smoking cigarettes using the IQOS, liked the taste, and experienced physical benefits. Dual users experienced more satisfaction from smoking cigarettes and used the IQOS for specific occasions, such as social situations or in places with smoking bans. All IQOS users described themselves as smokers and considered using the IQOS as an alternative way of smoking. Regulators may consider providing reliable and easily accessible information and regulating points of sale, promotional activities, and product properties such as flavors and devices in order to reduce product attractiveness and discourage use.
Collapse
|
27
|
Nitta NA, Sato T, Komura M, Yoshikawa H, Suzuki Y, Mitsui A, Kuwasaki E, Takahashi F, Kodama Y, Seyama K, Takahashi K. Exposure to the heated tobacco product IQOS generates apoptosis-mediated pulmonary emphysema in murine lungs. Am J Physiol Lung Cell Mol Physiol 2022; 322:L699-L711. [PMID: 35380471 DOI: 10.1152/ajplung.00215.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
Pulmonary emphysema is predominantly caused by chronic exposure to cigarette smoke (CS). Novel tobacco substitutes, such as heated tobacco products (HTPs), have emerged as healthier alternatives to cigarettes. IQOS, the most popular HTP in Japan, is advertised as harmless compared with conventional cigarettes. Although some studies have reported its toxicity, few in vivo studies have been conducted. Here, 12-wk-old C57BL6/J male mice were divided into three groups and exposed to air (as control), IQOS aerosol, or CS for 6 mo. After exposure, the weight gain was significantly suppressed in the IQOS and CS groups compared with the control (-4.93 g; IQOS vs. air and -5.504 g; CS vs. air). The serum cotinine level was significantly higher in the IQOS group than in the control group. The neutrophils and lymphocyte count increased in the bronchoalveolar lavage fluid of the IQOS and CS groups compared with those in the control group. Chronic IQOS exposure induced pulmonary emphysema similar to that observed in the CS group. Furthermore, expression levels of the genes involved in the apoptosis-related pathways were significantly upregulated in the lungs of the IQOS-exposed mice. Cytochrome c, cleaved caspase-3, and cleaved poly (ADP-ribose) polymerase-1 were overexpressed in the IQOS group compared with the control. Single-stranded DNA and TdT-mediated dUTP nick-end labeling-positive alveolar septal cell count significantly increased in the IQOS group compared with the control. In conclusion, chronic exposure to IQOS aerosol induces pulmonary emphysema predominantly via apoptosis-related pathways. This suggests that HTPs are not completely safe tobacco products.
Collapse
Affiliation(s)
- Naoko Arano Nitta
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tadashi Sato
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Moegi Komura
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hitomi Yoshikawa
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yohei Suzuki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Aki Mitsui
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eriko Kuwasaki
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Fumiyuki Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuzo Kodama
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kuniaki Seyama
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
28
|
Cruz-Jiménez L, Barrientos-Gutiérrez I, Zavala-Arciniega L, Arillo-Santillán E, Gallegos-Carrillo K, Rodríguez-Bolaños R, Gravely S, Thrasher JF. Heated tobacco product use, its correlates, and reasons for use among Mexican smokers. Drug Alcohol Depend 2022; 232:109283. [PMID: 35134734 PMCID: PMC9390091 DOI: 10.1016/j.drugalcdep.2022.109283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the use of novel heated tobacco products (HTPs) in low- and middle-income countries. We examined among smokers in Mexico the prevalence and correlates of HTP use, as well as reasons for using HTPs. METHODS We analyzed data from five surveys (November 2019-March 2021) of an open cohort of adult smokers (n = 6500), including an oversample of those who also use e-cigarettes. Mixed-effects multinomial logistic models were used to estimate associations between study variables and current HTP use or prior HTP trial relative to never trying HTPs. RESULTS The weighted prevalence of current HTP use was 1.1%. Independent correlates of current HTP use included smoking frequency, intention to quit, e-cigarette use, having partners/family-members who use e-cigarettes, friends who use HTPs, and exposure to HTP information inside/outside tobacco shops. Having partners/family members who smoke and not knowing about the harm of HTPs relative to cigarettes were associated with lower likelihood of current HTP use. Having tried HTPs was more likely among light daily smokers, those with family who use HTPs and exposure to HTP information outside shops and on newspapers/magazines. Among current users, the top reasons for using HTPs were greater social acceptability (50.6%) and lower perceived harm (34.9%) relative to cigarettes. CONCLUSIONS Uptake of HTPs appears relatively low among Mexican smokers, and correlates of use are similar to those for e-cigarette use. Further research is needed to determine if HTPs use promotes or impedes smoking cessation, given current HTP users are also likely to use various nicotine products.
Collapse
Affiliation(s)
- Lizeth Cruz-Jiménez
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Inti Barrientos-Gutiérrez
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Katia Gallegos-Carrillo
- Evaluation and Survey Research Center, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Cuernavaca, Morelos, Mexico
| | | | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - James F Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA.
| |
Collapse
|
29
|
Ling PM, Kim M, Egbe CO, Patanavanich R, Pinho M, Hendlin Y. Moving targets: how the rapidly changing tobacco and nicotine landscape creates advertising and promotion policy challenges. Tob Control 2022; 31:222-228. [PMID: 35241592 PMCID: PMC9233523 DOI: 10.1136/tobaccocontrol-2021-056552] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/01/2021] [Indexed: 01/18/2023]
Abstract
Tobacco, nicotine and related products have and continue to change rapidly, creating new challenges for policies regulating their advertising, promotion, sponsorship and sales. This paper reviews recent commercial product offerings and the regulatory challenges associated with them. This includes electronic nicotine delivery systems, electronic non-nicotine delivery systems, personal vaporisers, heated tobacco products, nicotine salts, tobacco-free nicotine products, other nicotine products resembling nicotine replacement therapies, and various vitamin and cannabis products that share delivery devices or marketing channels with tobacco products. There is substantial variation in the availability of these tobacco, nicotine, vaporised, and related products globally, and policies regulating these products also vary substantially between countries. Many of these products avoid regulation by exploiting loopholes in the definition of tobacco or nicotine products, or by occupying a regulatory grey area where authority is unclear. These challenges will increase as the tobacco industry continues to diversify its product portfolio, and weaponises 'tobacco harm reduction' rhetoric to undermine policies limiting marketing, promotion and taxation of tobacco, nicotine and related products. Tobacco control policy often lags behind the evolution of the industry, which may continue to sell these products for years while regulations are established, refined or enforced. Policies that anticipate commercial tobacco, nicotine and related product and marketing changes and that are broad enough to cover these product developments are needed.
Collapse
Affiliation(s)
- Pamela M Ling
- Department of Medicine and Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, USA
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Roengrudee Patanavanich
- Department of Community Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
| | - Mariana Pinho
- Tobacco Control Project, ACT Health Promotion (Brazil), Rio de Janeiro, Brazil
| | - Yogi Hendlin
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
30
|
O'Connor R, Schneller LM, Felicione NJ, Talhout R, Goniewicz ML, Ashley DL. Evolution of tobacco products: recent history and future directions. Tob Control 2022; 31:175-182. [PMID: 35241585 DOI: 10.1136/tobaccocontrol-2021-056544] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022]
Abstract
Declines in cigarette smoking prevalence in many countries and the consolidation of the tobacco industry have prompted the introduction of other forms of nicotine delivery. These include electronic nicotine delivery systems (ENDS), heated tobacco products (HTPs) and oral nicotine products (ONPs). Evolving over time, some of these products now deliver nicotine at levels comparable to cigarettes and may serve as effective substitutes for smokers. However, certain products, especially ENDS like JUUL, have also appealed to youth and non-smokers, prompting concerns about expanding nicotine use (and potentially nicotine addiction). The tobacco industry could shift away from primarily promoting cigarettes to promoting ENDS, HTPs and/or ONPs, though at this time it continues to heavily promote cigarettes in low and middle-income countries. Differing regulatory regimes may place upward and downward pressures on both cigarettes and these newer products in terms of population use, and may ultimately drive the extent to which cigarettes are or are not displaced by ENDS, HTPs and/or ONPs in the coming decade.
Collapse
Affiliation(s)
- Richard O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA richard.o'
| | - Liane M Schneller
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Nicholas J Felicione
- Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Reinskje Talhout
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| |
Collapse
|
31
|
Vivarelli F, Canistro D, Cirillo S, Elias RJ, Granata S, Mussoni M, Burattini S, Falcieri E, Turrini E, Fimognari C, Buschini A, Lazzaretti M, Beghi S, Girotti S, Sangiorgi S, Bolelli L, Ghini S, Ferri EN, Fagiolino I, Franchi P, Lucarini M, Mercatante D, Rodriguez-Estrada MT, Lorenzini A, Marchionni S, Gabriele M, Longo V, Paolini M. Unburned Tobacco Cigarette Smoke Alters Rat Ultrastructural Lung Airways and DNA. Nicotine Tob Res 2021; 23:2127-2134. [PMID: 34036368 DOI: 10.1093/ntr/ntab108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Recently, the Food and Drug Administration authorized the marketing of IQOS Tobacco Heating System as a Modified Risk Tobacco Product based on an electronic heat-not-burn technology that purports to reduce the risk. METHODS Sprague-Dawley rats were exposed in a whole-body mode to IQOS aerosol for 4 weeks. We performed the chemical characterization of IQOS mainstream and we studied the ultrastructural changes in trachea and lung parenchyma of rats exposed to IQOS stick mainstream and tissue pro-inflammatory markers. We investigated the reactive oxygen species amount along with the markers of tissue and DNA oxidative damage. Moreover, we tested the putative genotoxicity of IQOS mainstream through Ames and alkaline Comet mutagenicity assays. RESULTS Here, we identified irritating and carcinogenic compounds including aldehydes and polycyclic aromatic hydrocarbons in the IQOS mainstream as sign of incomplete combustion and degradation of tobacco, that lead to severe remodelling of smaller and largest rat airways. We demonstrated that IQOS mainstream induces lung enzymes that activate carcinogens, increases tissue reactive radical concentration; promotes oxidative DNA breaks and gene level DNA damage; and stimulates mitogen activated protein kinase pathway which is involved in the conventional tobacco smoke-induced cancer progression. CONCLUSIONS Collectively, our findings reveal that IQOS causes grave lung damage and promotes factors that increase cancer risk. IMPLICATIONS IQOS has been proposed as a safer alternative to conventional cigarettes, due to depressed concentration of various harmful constituents typical of traditional tobacco smoke. However, its lower health risks to consumers have yet to be determined. Our findings confirm that IQOS mainstream contains pyrolysis and thermogenic degradation by-products, the same harmful constituents of traditional cigarette smoke, and, for the first time, we show that it causes grave lung damage and promotes factors that increase cancer risk in the animal model.
Collapse
Affiliation(s)
- Fabio Vivarelli
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Donatella Canistro
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Silvia Cirillo
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Ryan J Elias
- Department of Food Science, College of Agricultural Sciences, Pennsylvania State University, University Park, PA, USA
| | - Silvia Granata
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Matilde Mussoni
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Sabrina Burattini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Elisabetta Falcieri
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Eleonora Turrini
- Department for Life Quality Studies, Alma Mater Studiorum-University of Bologna, Rimini, Italy
| | - Carmela Fimognari
- Department for Life Quality Studies, Alma Mater Studiorum-University of Bologna, Rimini, Italy
| | - Annamaria Buschini
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Mirca Lazzaretti
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Sofia Beghi
- Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Stefano Girotti
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Stefano Sangiorgi
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Luca Bolelli
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Severino Ghini
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Elida Nora Ferri
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | | | - Paola Franchi
- Department of Chemistry "G. Ciamician," Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Marco Lucarini
- Department of Chemistry "G. Ciamician," Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Dario Mercatante
- Department of Agricultural and Food Sciences, Alma Mater Studiorum-University di Bologna, Bologna, Italy
| | - Maria Teresa Rodriguez-Estrada
- Department of Agricultural and Food Sciences, Alma Mater Studiorum-University di Bologna, Bologna, Italy
- Inter-Departmental Centre for Agri-Food Industrial Research, Alma Mater Studiorum-University of Bologna, Cesena, Italy
| | - Antonello Lorenzini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Silvia Marchionni
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| | - Morena Gabriele
- Department of Agricultural Biology and Biotechnology, CNR, Pisa, Italy
| | - Vincenzo Longo
- Department of Agricultural Biology and Biotechnology, CNR, Pisa, Italy
| | - Moreno Paolini
- Department of Pharmacy and Biotechnology, Alma Mater Studiorum-University of Bologna, Bologna,Italy
| |
Collapse
|
32
|
Mays D, Johnson AC, Glasser A, Mercincavage M, Strasser AA. Effects of IQOS health warnings and modified risk claims among young adult cigarette smokers and non-smokers. Tob Control 2021:tobaccocontrol-2021-056810. [PMID: 34716283 PMCID: PMC9050959 DOI: 10.1136/tobaccocontrol-2021-056810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/18/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Heated tobacco products, including Marlboro IQOS, are available globally. In the USA, IQOS was authorised to be advertised with claims about reduced toxicant exposure relative to cigarettes. The effects of such modified risk claims and health warnings have not been studied among young adult cigarette smokers and non-smokers. METHODS In 2020, US young adult (18-30 years, n=1328) cigarette smokers and non-smokers viewed an IQOS ad in a 4 (modified risk claim variations or none) by 3 (warning variations or none) between-subjects experiment. Outcome measures assessed perceived credibility and effectiveness of the health or risk message for discouraging IQOS use, perceived harms, efficacy beliefs, and IQOS use intentions. RESULTS Smokers reported significantly higher (p<0.05) perceived credibility, lower perceived effectiveness, higher efficacy beliefs about switching to IQOS and higher intentions to use IQOS than non-smokers. Among smokers, health warnings increased perceived credibility (p<0.001) and effectiveness (p<0.05), but claims did not affect outcomes examined. Among non-smokers, warnings and claims increased perceived credibility, and warnings increased perceived effectiveness (p<0.003). The reduced exposure claim increased non-smokers' intentions to use IQOS (b=0.40, 95% CI 0.07 to 0.73). CONCLUSIONS Among young adult smokers, health warnings increased perceived effectiveness at discouraging IQOS use and perceived credibility. Among non-smokers, warnings and claims increased perceived credibility and warnings increased perceived effectiveness, but the Food and Drug Administration-authorised reduced exposure claim increased intentions to use IQOS. Research is warranted to understand how the content of modified risk claims and health warnings for IQOS affects IQOS use in this population.
Collapse
Affiliation(s)
- Darren Mays
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Allison Glasser
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
33
|
Berg CJ, Abroms LC, Levine H, Romm KF, Khayat A, Wysota CN, Duan Z, Bar-Zeev Y. IQOS Marketing in the US: The Need to Study the Impact of FDA Modified Exposure Authorization, Marketing Distribution Channels, and Potential Targeting of Consumers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10551. [PMID: 34639851 PMCID: PMC8508084 DOI: 10.3390/ijerph181910551] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 02/01/2023]
Abstract
IQOS, the leading heated tobacco product globally, recently received 'reduced exposure' authorization from the US Food and Drug Administration. Independent research focusing on IQOS marketing and potential impact on consumers' perceptions and behavior, and ultimately public health, is critical. The literature to date has underscored several concerns. First, Philip Morris's (PM's) marketing distribution requires scrutiny, particularly given its innovative promotional strategies. For example, IQOS is distributed via unique points-of-sale (POS; e.g., specialty and pop-up stores, "corners" in convenience stores) and uses various other opportunities (e.g., social media, sponsored events, direct-to-consumer). Second, although PM claims that IQOS' target market is current combustible tobacco users and not young people, the literature indicates that in some populations, IQOS use is equally prominent among smokers and nonsmokers, and that specific subgroups (e.g., young adults, women) are targeted. Third, the impact of IQOS' use of ad content promoting IQOS health benefits must be studied (e.g., how consumers interpret modified exposure messages). In conclusion, surveillance of IQOS marketing, particularly following reduced exposure authorization, is critical for obtaining valuable data to estimate population impact, particularly among population subgroups (e.g., young adults), and inform future tobacco regulation. These considerations have implications beyond IQOS-to other products and companies.
Collapse
Affiliation(s)
- Carla J. Berg
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (L.C.A.); (K.F.R.); (C.N.W.); (Z.D.)
- GW Cancer Center, George Washington University, Washington, DC 20052, USA
| | - Lorien C. Abroms
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (L.C.A.); (K.F.R.); (C.N.W.); (Z.D.)
- GW Cancer Center, George Washington University, Washington, DC 20052, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem 9112102, Israel; (H.L.); (A.K.); (Y.B.-Z.)
| | - Katelyn F. Romm
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (L.C.A.); (K.F.R.); (C.N.W.); (Z.D.)
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem 9112102, Israel; (H.L.); (A.K.); (Y.B.-Z.)
| | - Christina N. Wysota
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (L.C.A.); (K.F.R.); (C.N.W.); (Z.D.)
| | - Zongshuan Duan
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (L.C.A.); (K.F.R.); (C.N.W.); (Z.D.)
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem 9112102, Israel; (H.L.); (A.K.); (Y.B.-Z.)
| |
Collapse
|
34
|
Effective package warning label systems for communicating relative risks of cigarettes, heated tobacco products, and e-cigarettes: An experimental study with Korean adults. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103468. [PMID: 34624731 DOI: 10.1016/j.drugpo.2021.103468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Warning labels are a fundamental public health strategy for communicating about tobacco product risks, but effective warning labels for heated tobacco products (HTPs) and e-cigarettes (ECs) are yet to be determined. We examined the effect of two warning label systems for communicating the relative risks of using cigarettes, HTPs, and ECs. METHODS 1,280 Korean adults were recruited from an online commercial panel, including susceptible non-users of cigarettes, HTPs, or ECs aged 19 to 29 (n = 444) and current users of these tobacco products aged 19 or older (n = 836). Participants viewed packages for cigarettes, HTPs, and ECs in a 2 × 2 between-subject experiment: "dashboard" icons integrated into warnings vs. no dashboard; different-sized warnings (70% of cigarette packages, 50% of HTP packs, 30% of EC packages) vs. current equal-sized warnings (50% of cigarette/HTP/EC packages). RESULTS Participants exposed to the dashboard warning system were more likely than those who were not to report higher perceived harm of cigarettes than ECs, cigarettes than HTPs, and HTPs than ECs, as well as perceived benefit of switching from cigarettes to HTPs, cigarettes to ECs, and HTPs to ECs. Participants exposed to the different-sized warning system did not report differences in perceived relative harm or benefit compared to those who were not, and no interaction of dashboard warnings with warning sizes was found. CONCLUSION The use of dashboard icons with texts and colors representing different levels of risk may promote public understanding about the continuum of risk across tobacco products.
Collapse
|
35
|
Zaitsu M, Hosokawa Y, Okawa S, Hori A, Kobashi G, Tabuchi T. Heated tobacco product use and hypertensive disorders of pregnancy and low birth weight: analysis of a cross-sectional, web-based survey in Japan. BMJ Open 2021; 11:e052976. [PMID: 34548366 PMCID: PMC8458368 DOI: 10.1136/bmjopen-2021-052976] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Knowledge on the impact of heated tobacco product (HTP) use in pregnant women with associated maternal and neonatal risks for hypertensive disorders of pregnancy (HDP) and low birth weight (LBW) is limited. We aimed to assess the status of HTP use among pregnant women in Japan and explore the association of HTP use with HDP and LBW. DESIGN Cross-sectional study. SETTING Data from the Japan 'COVID-19 and Society' Internet Survey study, a web-based nationwide survey. PARTICIPANTS We investigated 558 postdelivery and 365 currently pregnant women in October 2020. PRIMARY AND SECONDARY OUTCOME MEASURES Information on HDP and LBW was collected from the postdelivery women's Maternal and Child Health Handbooks (maternal and newborn records). We estimated the age-adjusted ORs and 95% CIs of ever HTP smokers for HDP and LBW and compared them with those of never HTP smokers in a logistic regression analysis. RESULTS The prevalence of ever and current HTP use were 11.7% and 2.7% in postdelivery women and 12.6% and 1.1% in currently pregnant women, respectively. Among currently pregnant women who were former combustible cigarette smokers, 4.4% (4/91) were current HTP smokers. Among postdelivery women, ever HTP smokers had a higher HDP incidence (13.8% vs 6.5%, p=0.03; age-adjusted OR=2.48, 95% CI 1.11 to 5.53) and higher LBW incidence (18.5% vs 8.9%, p=0.02; age-adjusted OR=2.36, 95% CI 1.16 to 4.87). CONCLUSIONS In Japan, the incidence of ever HTP use exceeded 10% among pregnant women, and HTP smoking may be associated with maternal and neonatal risks.
Collapse
Affiliation(s)
- Masayoshi Zaitsu
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Japan
| | - Yoshihiko Hosokawa
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Japan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ai Hori
- Department of Global Public Health, University of Tsukuba, Tsukuba, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| |
Collapse
|
36
|
Myagmar-Ochir E, Kaneko M, Tomiyama K, Zaitsu M, Watanabe S, Nishino Y, Takahashi K, Haruyama Y, Kobashi G. Occupational difference in use of heated tobacco products: a cross-sectional analysis of retail workers in Japan. BMJ Open 2021; 11:e049395. [PMID: 34429314 PMCID: PMC8386230 DOI: 10.1136/bmjopen-2021-049395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Although heated tobacco products (HTPs) have become popular worldwide, research on occupational differences in smoking HTPs remains scarce. We aimed to examine the prevalence of smoking HTPs among a working population in Japan. SETTING, DESIGN AND PARTICIPANTS In 2018, we conducted a cross-sectional study comprised of 7714 retail business workers in the service industry in Japan. PRIMARY AND SECONDARY OUTCOME MEASURES For the definition of smoking HTPs, we identified current HTP smokers who only smoked HTPs, using five mutual categories of current smoking status (never, former, HTPs only, combustible cigarettes only and dual smokers who smoked both combustible cigarettes and HTPs). Occupational classes were classified into office workers (eg, upper non-manual workers) and other workers. ORs and 95% CIs of office workers were estimated for HTP usage, adjusted for age, sex, employment type and cigarette smoking-related health knowledge. RESULTS The overall prevalence of smoking HTPs was 3.0% (male 5.0%, female 2.2%). The prevalence of HTP smokers differed across occupational classes (5.6% in office workers vs 2.5% in others; p<0.05). Compared with other workers, the adjusted odds of office workers for smoking HTPs remained elevated (OR: 1.97, 95% CI: 1.40 to 2.77). Sensitivity analyses with workers of all smoking status showed the same pattern. When stratified by sex, the occupational difference only remained significant in male workers. CONCLUSIONS We found a positive occupational difference in smoking HTPs, particularly among male workers in the retail sector in Japan. National tobacco control should explicitly address this occupational gap and further encourage individuals to quit smoking.
Collapse
Affiliation(s)
- Enkhtuguldur Myagmar-Ochir
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Makiko Kaneko
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Kiyomi Tomiyama
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Masayoshi Zaitsu
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Shuichi Watanabe
- Division of Health Support, Department Store Health Insurance Association, Tokyo, Japan
| | - Yoshitaka Nishino
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Kyo Takahashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Shimotsuga-gun, Tochigi, Japan
| |
Collapse
|
37
|
Li S, Braden K, Zhuang YL, Zhu SH. Adolescent Use of and Susceptibility to Heated Tobacco Products. Pediatrics 2021; 148:peds.2020-049597. [PMID: 34312293 DOI: 10.1542/peds.2020-049597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A leading brand of heated tobacco products (HTPs), IQOS, was authorized to be sold in the United States in 2019. Researchers have examined the awareness and use of HTPs among US adults. In this study, we examined high school students' awareness, use, and susceptibility pertaining to HTPs. METHODS A large, cross-sectional population survey of randomly sampled 10th- and 12th-graders in California (N = 150 516) was conducted online during school hours from September 2019 to March 2020. RESULTS Overall, 8.9% (95% confidence interval [CI], 8.7%-9.1%) of California high school students had heard of HTPs. Approximately 0.67% (95% CI, 0.61%-0.73%) had ever tried HTPs, and 0.20% (95% CI, 0.17%-0.23%) were current users (ie, ∼30% of ever users continued to use HTPs at the time of survey). Among those who never tried HTPs, 18.3% (95% CI, 17.9%-18.8%) were susceptible to future use. The susceptibility to HTP use was greater among users of cigarettes or e-cigarettes than among nonusers. CONCLUSIONS The awareness of HTPs among adolescents was remarkable given the low availability of products at the time of survey. Only a small percentage of adolescents experimented with HTPs. However, almost a third of those who had experimented with HTPs continued to use them. This high ratio and the fact that almost 1 out of 5 never users were susceptible to future HTP use should put the public health community on high alert as more HTP products are coming into the market, with promotion of these products likely to increase.
Collapse
Affiliation(s)
| | | | | | - Shu-Hong Zhu
- Moores Cancer Center and .,Herbert Wertheim School of Public Healh, University of California San Diego, La Jolla, California
| |
Collapse
|
38
|
Hwang J, Cho SI. A comparative study on changes in the use of heat-not-burn tobacco products based on whether apartment buildings have designated non-smoking areas. Tob Prev Cessat 2021; 7:46. [PMID: 34179592 PMCID: PMC8202528 DOI: 10.18332/tpc/136028] [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: 08/24/2020] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Since 2016, multi-family housing developments in South Korea can designate public areas such as staircases, elevator, corridors, and underground parking lots as non-smoking areas if at least half of the households residing in the development agree. This study investigated whether there were changes in the use of heat-not-burn tobacco products (HnB) based on whether non-smoking areas were introduced in multi-family housing developments. METHODS An online survey of 1200 apartment residents (599 men and 601 women) in seven metropolitan cities in South Korea was conducted from 10 to 18 October 2018. RESULTS Among the 1200 people who completed the survey, 493 were smokers (351 men and 142 women), of whom 287 (195 men and 92 women) were currently using HnB. In total, 51.5% (n=148) of the HnB users reported that their smoking frequency inside (n=75) or outside (n=73) the apartment building increased after using HnB, whereas the smoking frequency of 27.5% (n=79) decreased and that of 20.9% (n=6) remained unchanged. Of the HnB users, 25.4% (n=73) were currently living in non-smoking apartments, of whom 39.7% reported that the smoking frequency outside the apartment building increased. On the other hand, of 214 people who did not currently reside in non-smoking apartments, 30.4% reported that the smoking frequency in the apartment increased. CONCLUSIONS For smokers to quit smoking, the expansion of non-smoking areas should be accompanied by the facilitation of a smoke-free atmosphere and a smoking-cessation service for smokers.
Collapse
Affiliation(s)
- Jieun Hwang
- College of Health Science, Dankook University, Cheonan, Republic of Korea
| | - Sung-Il Cho
- College of Health Science, Dankook University, Cheonan, Republic of Korea.,Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
39
|
Kim J, Lee S, Kimm H, Lee JA, Lee CM, Cho HJ. Heated tobacco product use and its relationship to quitting combustible cigarettes in Korean adults. PLoS One 2021; 16:e0251243. [PMID: 33961641 PMCID: PMC8104442 DOI: 10.1371/journal.pone.0251243] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We assessed the prevalence of, and factors associated with, heated tobacco product (HTP) use and analysed the association between HTP use and quitting combustible cigarettes (CCs) in Korean adults. METHODS We conducted an online survey with 7,000 adults (males, 2,300; females, 4,700; ages 20-69) out of 70,000 age-, sex- and provincial-distribution-matched individuals based on 2018 national population statistics. Females were oversampled because the prevalence of tobacco product use is very low among women in Korea. Chi-square tests were used for bivariate analyses, and odds ratios were assessed after adjusting for sociodemographic variables. RESULTS The prevalence of current CC, electronic cigarette (EC), and HTP use was 24.8% (males, 40.4%; females, 9.3%), 6.8% (males, 10.1%; females, 3.4%), and 10.2% (males, 16.2%; females, 4.3%), respectively. Among the 574 current HTP users, 77 (13.4%) were HTP-only users and >80% were either dual users of HTP and CC/EC, or triple users of HTP, EC, and CC. Among the current CC users, the odds of having attempted to quit CCs in the past year were greater among EC-only users (aOR 2.92; 95% CI 1.81-4.69) and dual users of HTPs and ECs (aOR 8.42; 95% CI 4.85-14.62) than among non-HTP and non-EC users. Among 2,121 ever CC smokers, the likelihood of being a former CC smoker was 0.19 (95% CI 0.15-0.24) for HTP users, 0.29 (95% CI 0.20-0.42) for EC users, and 0.03 (95% CI 0.01-0.06) for users of both HTPs and ECs compared with non-HTP and non-EC users. CONCLUSION EC-only use and dual use of HTPs and ECs were associated with increased attempts to quit CCs; however, HTP and EC use was associated with lower odds of CC smoking abstinence.
Collapse
Affiliation(s)
- Jinyoung Kim
- Southern Gyeonggi Regional Smoking Cessation Centre, Hallym University, Anyang, Republic of Korea
| | - Sungkyu Lee
- Korea Tobacco Control Research and Education Centre, Seoul, Republic of Korea
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Heejin Kimm
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Juna-Ah Lee
- Department of Family Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheol-min Lee
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
40
|
Liu J, Phua J, Krugman D, Xu L, Nowak G, Popova L. Do Young Adults Attend to Health Warnings in the First IQOS Advertisement in the U.S.? An Eye-Tracking Approach. Nicotine Tob Res 2021; 23:815-822. [PMID: 33245339 PMCID: PMC8628649 DOI: 10.1093/ntr/ntaa243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/20/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In October 2019, a heated tobacco product (HTP) IQOS debuted in the United States. This study examined young adults' attention and cognitions in response to an IQOS ad that carried two mandated textual health warnings (Surgeon General's warning and nicotine warning), and how their vaping and smoking status may interact with attention patterns to affect attitude and intention to use IQOS. METHODS In November 2019, college students (N = 164) viewed IQOS' first U.S. magazine ad and two distractor ads. Viewing patterns were recorded with eye-tracking. Masked recall and aided recognition, attitude and intention towards IQOS use were later assessed with self-report. Ordinary Least Squares (OLS) regressions and moderated mediation analyses examined the associations between visual attention and viewers' cognitions about IQOS use. RESULTS Promotional content attracted significantly more attention compared to the warnings. Attention to the Surgeon General's warning but not to the nicotine warning was associated with recall and recognition of the warning's content. For ever-vapers, greater attention allocation to the promotional content in the IQOS ad was associated with more favorable attitude toward IQOS use, which was in turn positively associated with intention to use IQOS. Attention allocation to the warnings did not affect attitude or intentions, regardless of tobacco use status. CONCLUSIONS The results revealed the effects of IQOS promotional content overshadowed the two health warnings in influencing young people's attitude and intention to use IQOS. Young adults who vaped were more vulnerable to HTP advertising with respect to future use and vaping may be a gateway to HTP use. IMPLICATIONS This is the first eye-tracking study examining attention and cognitions associated with the new IQOS ad exposure among young adults. Promotional content in the ad attracted significantly more attention than the two warnings combined. Attention to the Surgeon General's warning but not to the nicotine warning was associated with recall and recognition of the warning's content. Greater attention allocation to the promotional content led to a more favorable attitude toward IQOS use which was associated with increased intention to use IQOS for ever-vapers. However, greater attention allocation to the warnings did not affect attitude or intentions to use IQOS.
Collapse
Affiliation(s)
- Jiaying Liu
- Department of Communication Studies, University of
Georgia, Athens, GA, USA
| | - Joe Phua
- Department of Advertising and Public Relations, Grady College of
Journalism and Mass Communication, University of Georgia, Athens,
GA, USA
| | - Dean Krugman
- Department of Advertising and Public Relations, Grady College of
Journalism and Mass Communication, University of Georgia, Athens,
GA, USA
| | - Linjia Xu
- School of Chinese Language and Literature, University of International
Business and Economics, Beijing, China
| | - Glen Nowak
- Center for Health & Risk Communication, Grady College of
Journalism and Mass Communication, University of Georgia, Athens,
GA, USA
| | - Lucy Popova
- School of Public Health, Georgia State University,
Atlanta, GA, USA
| |
Collapse
|
41
|
Categorizing IQOS-Related Twitter Discussions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094836. [PMID: 33946546 PMCID: PMC8124933 DOI: 10.3390/ijerph18094836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
(1) Background: The heated tobacco product IQOS, by Philip Morris International, is now available in over 55 countries, including the United States. Social media sites such as Twitter are often used to promote or discuss tobacco products, though prior research has not examined how IQOS is presented on Twitter. (2) Methods: This study collected and categorized Twitter conversations involving IQOS. A manual content analysis was performed on N = 3916 English tweets related to IQOS published internationally between 1 January 2020 and 30 June 2020. (3) Results: Most tweets were either online marketing for IQOS (32.3%) or personal testimonials related to IQOS use (34.2%). Personal testimonial tweets made harm reduction claims about IQOS either as an avenue to quit smoking/tobacco use (3.4%), or in comparison to combustible cigarettes (2.0%). Tobacco policy-related tweets were detected (13.9%), split between discussions of United States (4.9%) and international (4.4%) policies. News media tweets (14.2%) were also detected. (4) Conclusions: Our study suggests IQOS may be understood as a less harmful alternative to vaping and combustible cigarettes. Discussions also suggest IQOS is likely to be used to avoid clean air policies or used in areas in which smoking is restricted.
Collapse
|
42
|
Tompkins CNE, Burnley A, McNeill A, Hitchman SC. Factors that influence smokers' and ex-smokers' use of IQOS: a qualitative study of IQOS users and ex-users in the UK. Tob Control 2021; 30:16-23. [PMID: 31941822 PMCID: PMC7803910 DOI: 10.1136/tobaccocontrol-2019-055306] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND One of the most widely available heated tobacco products is IQOS by Philip Morris International. However, there is a lack of independent research exploring IQOS initiation and subsequent use among smokers and ex-smokers. AIMS To (1) explore the reasons why smokers and ex-smokers use and continue/discontinue IQOS and (2) consider implications for future research and policy. PARTICIPANTS Adult (18+) current (n=22) and ex-users (n=8) of IQOS who either currently smoked or quit smoking in the last 2 years. METHODS Qualitative interview study in London, UK. RESULTS Six main factors influenced initiation and use of IQOS: (1) Health-wanting to reduce/quit smoking and perceptions of reduced harm (while understanding IQOS was not risk-free). Branded packaging, absence of pictorial warnings and physical health improvements conveyed reduced harm. (2) Financial-including high start-up costs, but cheaper ongoing costs than smoking. (3) Physical-mixed views on enjoyment and satisfaction. Sensory experiences influenced use including discreetness, cleanliness, reduced smell and tactile similarities relative to combustible cigarettes. (4) Practical-issues of accessibility, shortcomings with maintenance/operation limited ongoing use, whereas use in smoke-free places increased use. (5) Psychological-similarities in rituals and routines, although new practices developed to charge and clean; some liked trailblazing new technology. (6) Social-improved social interactions from using IQOS instead of smoking, but with more limited shared social experiences for some. CONCLUSION For some, IQOS facilitated smoking substitution. Factors such as packaging, labelling, risk communication, price and smoke-free policies appear to influence initiation and use.
Collapse
Affiliation(s)
- Charlotte N E Tompkins
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Annabel Burnley
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- SPECTRUM Consortium, UK - Shaping Public Health Policies To Reduce Inequalities and Harm, UK
| | - Sara C Hitchman
- Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
43
|
Chang LC, Lee YC, Hsu C, Chen PC. Prevalence of heated tobacco product use among adolescents in Taiwan. PLoS One 2020; 15:e0244218. [PMID: 33347476 PMCID: PMC7751857 DOI: 10.1371/journal.pone.0244218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the penetration of heated tobacco products (HTPs) into the youth market in Taiwan, with a particular focus on the correlation between IQOS use and the usage of other tobacco products. Methods Data from the 2018 Global Youth Tobacco Survey were used to assess previous experience with and current use (within 30 days prior to survey completion) of IQOS products by Taiwanese students aged 12–18 years. Independent variables included the usage patterns of conventional cigarettes and e-cigarettes. The control variables included background information (gender, grade, monthly income/allowance, household educational level, smoking status at home and among close friends), access to free cigarettes, as well as exposure to cigarette advertisements and anti-tobacco courses. Logistic regression was used to identify tobacco usage patterns correlated with IQOS use. Results In 2018, 2.33% of Taiwan’s adolescents were currently using IQOS and 4.17% had tried IQOS. The use of conventional cigarettes and e-cigarettes (individually and together) were associated with an elevated risk of the ever use and current use of IQOS. Conclusion Despite the fact that HTP products are not sold legally in Taiwan, the use of IQOS products by young people is far from negligible. We recommend amending the “Tobacco Hazards Prevention Act” to include regulations pertaining to the sale and marketing of HTPs.
Collapse
Affiliation(s)
- Li-Chuan Chang
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yue-Chune Lee
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Master Program on Trans-Disciplinary Long-Term Care and Management, National Yang-Ming University, Taipei, Taiwan
| | - Chieh Hsu
- Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ching Chen
- Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan
- * E-mail:
| |
Collapse
|
44
|
Kinjo A, Kuwabara Y, Fujii M, Imamoto A, Osaki Y, Minobe R, Maezato H, Nakayama H, Takimura T, Higuchi S. Heated Tobacco Product Smokers in Japan Identified by a Population-Based Survey. J Epidemiol 2020; 30:547-555. [PMID: 31787705 PMCID: PMC7661338 DOI: 10.2188/jea.je20190199] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In this study, we aim to estimate the prevalence of heated tobacco product (HTP) smokers 3 years after the launch of HTPs in Japan. Methods Our study, performed in February 2018 in Japan, had a cross-sectional population-based design. A total of 4,628 adult participants (2,121 men and 2,507 women) were randomly sampled from all regions of Japan. The response rate was 57.9%. Interviews were conducted by trained investigators who visited participants’ homes. A survey on current (past 30 days) and lifetime tobacco use (including e-cigarettes and HTPs), as well as numerous sociodemographic factors, was conducted. Results The age-adjusted rates and estimated number of lifetime-HTP smokers were 14.1% (95% confidence interval [CI], 12.5–15.6%; 7.11 million men) and 3.7% (95% CI, 2.9–4.4%; 1.99 million women). The age-adjusted rates for current HTP smokers were 8.3% (95% CI, 7.1–9.6%; 4.21 million men) and 1.9% (95% CI, 1.3–2.4%; 1.02 million women). Multiple variables were found to be associated with a higher prevalence of current HTP use, including being male, aged 20–39 years, a current Internet user, a risky drinker, or a heavy episodic drinker. HTP use was also higher among men with 10 years or more of education, women with 15 years or less of education, and men with middle- or high-level household incomes. Conclusion We concluded that HTP use has increased substantially in Japan. However, regulations for HTPs are weaker than those for combustible cigarettes in Japan. Thus, HTPs should be subjected to the same regulations as combustible tobacco products.
Collapse
Affiliation(s)
- Aya Kinjo
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Yuki Kuwabara
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Maya Fujii
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Aya Imamoto
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Yoneatsu Osaki
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University
| | - Ruriko Minobe
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Hitoshi Maezato
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Hideaki Nakayama
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Tsuyoshi Takimura
- National Hospital Organization Kurihama Medical and Addiction Center
| | - Susumu Higuchi
- National Hospital Organization Kurihama Medical and Addiction Center
| |
Collapse
|
45
|
Churchill V, Weaver SR, Spears CA, Huang J, Massey ZB, Fairman RT, Pechacek TF, Ashley DL, Popova L. IQOS debut in the USA: Philip Morris International's heated tobacco device introduced in Atlanta, Georgia. Tob Control 2020; 29:e152-e154. [PMID: 32024772 PMCID: PMC7416520 DOI: 10.1136/tobaccocontrol-2019-055488] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Victoria Churchill
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Scott R Weaver
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Zachary B Massey
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Robert T Fairman
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | | | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| |
Collapse
|
46
|
Watts C, Burton S, Freeman B. Creating a market for IQOS: analysis of Philip Morris' strategy to introduce heated tobacco products to the Australian consumer market. Tob Control 2020; 31:458-463. [PMID: 33191270 DOI: 10.1136/tobaccocontrol-2020-056057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Philip Morris International has made efforts to expand the sale of its heated tobacco product, IQOS, into new domestic markets globally. In Australia, where heated tobacco products are prohibited, the company recently attempted to overturn Australian legislation in order to permit their sale. In light of this recent move, this study presents a case study of the company's strategies to legalise and distribute IQOS in the Australian market. METHODS To assess Philip Morris' lobbying activities and corporate strategies, a case study approach was used by triangulating data from three sources: interviews with former Philip Morris employees, news articles reporting Philip Morris' lobbying activities or plans for IQOS in Australia, and submissions to relevant government inquiries and reviews from 2015 to 2020. RESULTS Philip Morris has actively lobbied Australian policy-makers to overturn bans on nicotine-containing products. Information obtained from key informants and Philip Morris' government submissions indicates that the company's goal is for heated tobacco products in Australia to be regulated in a new product category, exempt from tobacco control laws. Informants revealed that Philip Morris was also working to establish a network of upmarket pubs, clubs and bars where they could sell IQOS once legalisation was achieved. CONCLUSIONS Philip Morris has strongly lobbied the Australian government to legalise heated tobacco products, while simultaneously making plans to sell IQOS at young adult-friendly premises such as bars, clubs and pubs if its proposed legislative changes are made. This case study provides valuable insights for other countries where Philip Morris may be replicating similar strategies to weaken tobacco control legislation.
Collapse
Affiliation(s)
- Christina Watts
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia .,Cancer Prevention and Advocacy Division, Cancer Council New South Wales, Sydney, New South Wales, Australia
| | - Suzan Burton
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
47
|
Craig LV, Yoshimi I, Fong GT, Meng G, Yan M, Mochizuki Y, Tabuchi T, Thrasher JF, Xu SS, Quah ACK, Ouimet J, Sansone G, Chung-Hall J. Awareness of Marketing of Heated Tobacco Products and Cigarettes and Support for Tobacco Marketing Restrictions in Japan: Findings from the 2018 International Tobacco Control (ITC) Japan Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228418. [PMID: 33202995 PMCID: PMC7696863 DOI: 10.3390/ijerph17228418] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
Japan is one of the world’s largest cigarette markets and the top heated tobacco product (HTP) market. No forms of tobacco advertising, promotion, and sponsorship (TAPS) are banned under national law, although the industry has some voluntary TAPS restrictions. This study examines Japanese tobacco users’ self-reported exposure to cigarette and HTP marketing through eight channels, as well as their support for TAPS bans. Data are from the 2018 ITC Japan Survey, a cohort survey of adult exclusive cigarette smokers (n = 3288), exclusive HTP users (n = 164), HTP-cigarette dual users (n = 549), and non-users (n = 614). Measures of overall average exposure to the eight channels of cigarette and HTP advertising were constructed to examine differences in exposure across user groups and products. Dual users reported the highest exposure to cigarette and HTP advertising. Tobacco users (those who used cigarettes, HTPs, or both) reported higher average exposure to HTP compared to cigarette advertising, however non-users reported higher average exposure to cigarette compared to HTP advertising. Retail stores where tobacco or HTPs are sold were the most prevalent channel for HTP and cigarette advertising, reported by 30–43% of non-users to 66–71% of dual users. Non-users reported similar exposure to cigarette advertising via television and newspapers/magazines as cigarette smokers and dual users; however, advertising via websites/social media was lower among non-users and HTP users than among cigarette smokers and dual users (p < 0.05). Most respondents supported a ban on cigarette (54%) and HTP (60%) product displays in stores, and cigarette advertising in stores (58%).
Collapse
Affiliation(s)
- Lorraine V. Craig
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
- Correspondence:
| | - Itsuro Yoshimi
- Division of Tobacco Control Policy Research, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
- Ontario Institute for Cancer Research, 61 University Ave., Suite 510, Toronto, ON M5G 0A3, Canada
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Mi Yan
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Yumiko Mochizuki
- Japan Cancer Society, 13th Floor, Yurakucho Center Bldg. 2-5-1, Yurakucho, Chiyoda-ku, Tokyo 100-0006, Japan;
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Chome-1-69 Otemae, Chuo Ward, Osaka 541-8567, Japan;
| | - James F. Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Tobacco Research Department, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos 62100, Mexico
| | - Steve S. Xu
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Genevieve Sansone
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, 200 University Ave. W., Waterloo, ON N2L 3G1, Canada; (G.T.F.); (G.M.); (M.Y.); (S.S.X.); (A.C.K.Q.); (J.O.); (G.S.); (J.C.-H.)
| |
Collapse
|
48
|
Kim M, Watkins SL, Koester KA, Mock J, Kim HC, Olson S, Harvanko AM, Ling PM. Unboxed: US Young Adult Tobacco Users' Responses to a New Heated Tobacco Product. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8108. [PMID: 33153143 PMCID: PMC7662359 DOI: 10.3390/ijerph17218108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/28/2022]
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.
Collapse
Affiliation(s)
- Minji Kim
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
| | - Shannon Lea Watkins
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
| | - Kimberly A. Koester
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Jeremiah Mock
- Department of Social and Behavioral Sciences, Institute for Health & Aging, University of California, San Francisco, CA 94143, USA;
| | - Hyunjin Cindy Kim
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Sarah Olson
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| | - Arit Michael Harvanko
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA 94143, USA; (M.K.); (A.M.H.); (P.M.L.)
- Department of Medicine, University of California, San Francisco, CA 94143, USA; (K.A.K.); (H.C.K.); (S.O.)
| |
Collapse
|
49
|
Xu SS, Meng G, Yan M, Gravely S, Quah ACK, Ouimet J, O’Connor RJ, Sutanto E, Yoshimi I, Mochizuki Y, Tabuchi T, Fong GT. Reasons for Regularly Using Heated Tobacco Products among Adult Current and Former Smokers in Japan: Finding from 2018 ITC Japan Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8030. [PMID: 33142757 PMCID: PMC7663757 DOI: 10.3390/ijerph17218030] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 12/13/2022]
Abstract
The market growth of heated tobacco products (HTPs), such as IQOS, Ploom TECH, and glo, has increased dramatically in Japan since 2016. Little is known about the reasons why current and former smokers are using HTPs. The data for this cross-sectional study were from the 2018 (Wave 1) International Tobacco Control (ITC) Japan Survey, a national web-based survey of 4500 people, including 658 current HTP users, of whom 549 were concurrently smoking cigarettes and 109 were former smokers. The most common reasons for regularly using HTPs were: beliefs that HTP are less harmful than cigarettes to themselves (90.6%) or to others (86.7%), enjoyment (76.5%), and social acceptability (74.4%). About half of current smokers (55.1%) reported using HTPs because these products might help them quit smoking. However, a near-equal percentage (52.0%) of current smokers reported using HTPs to replace some of the cigarettes they smoked so that they did not have to give up smoking altogether. If smokers are using HTPs to complement rather than quit their smoking, then the harm reduction potential of HTPs suggested by the toxicity studies will be diminished.
Collapse
Affiliation(s)
- Steve S. Xu
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.M.); (M.Y.); (S.G.); (A.C.K.Q.); (J.O.); (G.T.F.)
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.M.); (M.Y.); (S.G.); (A.C.K.Q.); (J.O.); (G.T.F.)
| | - Mi Yan
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.M.); (M.Y.); (S.G.); (A.C.K.Q.); (J.O.); (G.T.F.)
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.M.); (M.Y.); (S.G.); (A.C.K.Q.); (J.O.); (G.T.F.)
| | - Anne C. K. Quah
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.M.); (M.Y.); (S.G.); (A.C.K.Q.); (J.O.); (G.T.F.)
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.M.); (M.Y.); (S.G.); (A.C.K.Q.); (J.O.); (G.T.F.)
| | - Richard J. O’Connor
- Division of Cancer Prevention and Population Sciences, Department of Health Behaviors Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA (E.S.)
| | - Edward Sutanto
- Division of Cancer Prevention and Population Sciences, Department of Health Behaviors Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA (E.S.)
| | - Itsuro Yoshimi
- Division of Tobacco Policy Research, National Cancer Center Japan, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Yumiko Mochizuki
- Japan Cancer Society, 13th Floor, Yurakucho Center Bldg. 2-5-1, Yurakucho, Chiyoda-ku, Tokyo 100-0006, Japan;
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Chome-1-69 Otemae, Chuo Ward, Osaka 541-8567, Japan;
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (G.M.); (M.Y.); (S.G.); (A.C.K.Q.); (J.O.); (G.T.F.)
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
| |
Collapse
|
50
|
Luk TT, Weng X, Wu YS, Chan HL, Lau CY, Kwong ACS, Lai VWY, Lam TH, Wang MP. Association of heated tobacco product use with smoking cessation in Chinese cigarette smokers in Hong Kong: a prospective study. Tob Control 2020; 30:653-659. [DOI: 10.1136/tobaccocontrol-2020-055857] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022]
Abstract
IntroductionHeated tobacco products (HTPs) are increasingly popular worldwide, but whether they aid or undermine cigarette abstinence remains uncertain. We examined the predictors of HTP initiation and the prospective association of HTP use with cigarette abstinence in community-based smokers in Hong Kong.DesignSecondary analysis of a randomised clinical trial aimed to evaluate the effectiveness of brief advice and referral for smoking cessation. The interventions were not related to HTP use.Participants and settings1213 carbon monoxide-verified daily cigarette smokers with intentions to quit or reduce smoking proactively recruited from community sites throughout Hong KongMain exposureCurrent (past 7 day) use of HTP at baseline.Main outcomeSelf-reported 7-day point-prevalence cigarette abstinence at 6 months (exclusive use of HTP permitted).ResultsAt baseline, 201 (16.6%) and 60 (4.9%) were ever and current HTP users, respectively. During the 6-month follow-up period, 110 of 1012 (10.9%) never users at baseline initiated HTPs. Younger age and higher education significantly predicted initiation. After adjusting for sociodemographic, smoking-related and quitting-related factors, current HTP use at baseline was not associated with cigarette abstinence at 6 months (adjusted prevalence ratio (aPR) 1.08, 95% CI 0.63 to 1.85). The results were similar in persistent users from baseline to 1-month/3-month follow-up (vs non-users; aPR 1.14, 95% CI 0.57 to 2.29). Use of smoking cessation service between baseline and 3-month follow-up significantly predicted cigarette abstinence (aPR 1.70, 95% CI 1.26 to 2.30).ConclusionHTP use was not associated with cigarette abstinence at 6 months in a community-based cohort of smokers with intentions to quit or reduce smoking.Trial registration detailsClinicalTrials.gov, NCT03565796.
Collapse
|