Background Beginning in the 1960s in the USA and globally since 1998, tobacco companies have beenaggressively promoting heated tobacco products (HTP). In 2016, Philip Morris International (PMI) applied to the US Food and Drug Administration (FDA) seeking authorisation to market their IQOS HTP system and flavoured ‘HeatSticks’ in the USA as a modified-risk tobacco product (MRTP). Methods We systematically evaluated the publicly available data PMI submitted to FDA in its MRTP application to determine whether PMI’s IQOS product meets the US Tobacco Control Act’s standard for MRTP claims. We examined whether PMI provided sufficient data showing tobacco users will not initiate with IQOS, that youth will not misperceive the MRTP-related claims being made concerning IQOS, and how youth perceive health risks associated with IQOS. Results PMI’s own studies failed to provide evidence that youth, including non-users and former users, will not find IQOS appealing, will not initiate use of IQOS and will not perceive these products as risk-free. Further, PMI did not refer to independent studies conducted among adolescents which could influence their conclusions. Finally, their studies suffered from design and implementation flaws and cannot be relied on to support the proffered claims. Conclusion PMI’s own data and available evidence from scientific studies conducted independent of the tobacco industry regarding how novel tobacco products are currently being marketed suggest that introduction of IQOS will result in adolescent and young adult non-users initiating tobacco use with IQOS and could also increase poly-use of IQOS along with other tobacco products.

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.

Heat-not-burn tobacco products include electric devices that heat modified cigarettes to produce an aerosol for inhalation without causing combustion.1–3 In line with recent tobacco industry effort to diversify their product portfolio,4 various new heat-not-burn devices have been introduced since 2014 in selected markets such as the UK, Italy and Japan—including Philip Morris International (PMI)’s IQOS i.1 5 Industry analysts predict that heat-not-burn products will absorb 30% of the US regular cigarette market by 2025.2 This manuscript describes PMI’s marketing of IQOS in South Korea based on news monitoring and direct observation by the author during two visits to the flagship stores in Seoul (June 2017) and the purchase of an IQOS device from one store. While currently available in selected markets only, the tobacco industry is expanding the reach of heat-not-burn tobacco products: PMI submitted a Modified Risk Tobacco Product (MRTP) application to the US Food and Drug Administration (FDA) in December 20166 and is planning to offer IQOS in 30+ countries within 2017.3 PMI started selling IQOS and the packs of modified cigarettes (called HEETS ii) in two flagship stores in Seoul, Korea on 27 May 2017. On 5 June 2017, other retail outlets in Seoul including CU (Korea’s largest convenience store chain7) and Electromart (an electronics specialty francise8) started selling them. The device costs 120 000 Korean Won (KRW; approximately US$105); a pack of 20 HEETS are priced at 4300 KRW, similar to regular cigarettes (4500 KRW/pack). As the manufacturer’s warranty for IQOS in Korea covers up to 7300 HEETS (based on the number of recharges to the battery), assuming this …

This study examined the effect of exposure to “cigalike” (products resembling cigarettes) e-cigarette advertisements on adolescents’ perceptions of cigarettes. A nationally representative sample of 802 adolescents (13–17 years old) was randomly assigned to watch three e-cigarette or three control advertisements. Never-smokers who saw the e-cigarette advertisements (n = 352) reported significantly lower perceived risks of smoking than those in the control condition (n = 320). Ever-smokers (n = 130) did not show significant differences across the conditions. In subgroup analyses, current smokers (reported smoking in the past 30 days, n = 31) in the e-cigarette condition reported significantly lower perceived benefits of smoking than those in the control condition. E-cigarette advertisements can affect adolescents’ perceptions of cigarettes. Many advertisements, especially the ones promoting “cigalikes,” depict e-cigarettes as being similar to cigarettes (e.g., look, flavor) but also as a solution for cigarettes’ shortcomings (e.g., bad smell). While the advertisements include messages about problems posed by cigarettes, proposing e-cigarettes as a solution may decrease the perceived risks of smoking among never-smokers. It may also not be clear to adolescents whether advertisements are for cigarettes or e-cigarettes. Regulating e-cigarette advertisements to minimize adolescents’ exposure may prevent potential harmful effects on never-smokers’ perception of smoking.

This study assesses the impact of character–audience similarity, a core aspect of tailored communication, on evaluation of antismoking public service announcements (PSAs). Smoker and persuader characters are distinguished to explore their different roles in message effectiveness. Daily adult smokers (n = 1,160) were exposed to four video PSAs randomly selected from a larger pool. Similarity scores were determined from matching in demographic (age, gender, race) and motivational factors (quitting status) between the audience and the PSA’s characters. Results show that PSAs featuring distinctive smoker and/or persuader characters yielded significantly higher message engagement and perceived effectiveness (PE) than PSAs without characters. Given the presence of characters, smoker–audience similarity was positively associated with the engagement, which in turn enhanced PE. Persuader–audience similarity failed to predict increases in either engagement or PE.

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