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Evolving IQOS packaging designs change perceptions of product appeal, uniqueness, quality and safety: a randomised experiment, 2018, USA
  1. Joseph G L Lee1,2,
  2. Tiffany M Blanchflower3,
  3. Kevin F O'Brien4,
  4. Paige E Averett5,
  5. Leslie E Cofie1,
  6. Kyle R Gregory1
  1. 1 Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
  2. 2 University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
  3. 3 Department of Interior Design and Merchandising, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
  4. 4 Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, North Carolina, USA
  5. 5 School of Social Work, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
  1. Correspondence to Dr Joseph G L Lee, College of Health and Human Performance, Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA; leejose14{at}


Background Globally, the tobacco industry is promoting heated tobacco products. These products may represent a strategy to promote dual use of tobacco products. One product, IQOS from Philip Morris International, is being proposed in the USA for marketing as a less harmful product. The visual design of tobacco products can influence consumers by implying product characteristics. Thus, we sought to test the impact of IQOS packaging designs on cognitive, affective and behavioural intention responses.

Methods From existing IQOS packages used globally, we developed three IQOS packages that decreasingly linked the product to the Marlboro brand. In September to October 2018, we assigned participants randomly to one package in an online experiment. All participants (n=954) were US adults reporting current smoking and no colour blindness. The experiment used quota sampling to ensure diversity by gender, sexual orientation, race, ethnicity and education. Measures were informed by the Context of Consumption Framework. To assess differences in ratings, we conducted non-parametric Kruskal–Wallis tests with post hoc comparisons using Dunn’s test.

Results We found significant differences in cognitive indicators including appeal (H=6.87, p=0.03), uniqueness (H=15.68, p<0.01), brand equity–quality (H=122.35, p<0.01) and perceived safety compared with other tobacco products (H=14.27, p<0.01). Participants rated packages similarly on affective and behavioural intention measures. All were rated low for talking to others about the product and high for interest in trying with a coupon.

Conclusion Linking or separating IQOS products with a well-established cigarette brand changes how adult smokers respond to the product. Regulators should consider the visual design of packaging.

  • public policy
  • non-cigarette tobacco products
  • advertising and promotion
  • tobacco industry

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  • Contributors JGLL, TMB and KRG designed the study. KFO provided expert advice on statistical analysis. JGLL conducted the analysis and drafted the manuscript. KRG provided technical assistance regarding laws and regulations. All authors provided critical feedback and edits to the manuscript.

  • Funding Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health and FDA Center for Tobacco Products (CTP) under Award Number R03CA212542. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

  • Competing interests None declared.

  • Patient and public involvement statement Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.