IQOS debut in the USA: Philip Morris International’s heated tobacco device introduced in Atlanta, Georgia
===========================================================================================================

* Victoria Churchill
* Scott R Weaver
* Claire Adams Spears
* Jidong Huang
* Zachary B. Massey
* Robert T Fairman
* Terry Frank Pechacek
* David L Ashley
* Lucy Popova

*   tobacco products
*   nicotine delivery devices

## Introduction

Following the Food and Drug Administration’s (FDA) April 2019 authorisation on their premarket tobacco product application,1 Philip Morris (PM) has officially launched its heated tobacco product, IQOS, in the USA in October 2019 in Atlanta, Georgia. IQOS consists of a charger and a holder, into which tobacco sticks, called ‘HeatSticks’ in the USA, are inserted (figure 1). The blade in the holder heats tobacco in a HeatStick, producing an aerosol. Prior to the US launch, IQOS was available in 43 countries. PM has also submitted to the FDA a modified risk tobacco product application for IQOS (decision pending).

![Figure 1](http://tobaccocontrol.bmj.com/https://tobaccocontrol.bmj.com/content/tobaccocontrol/29/e1/e152/F1.medium.gif)

[Figure 1](http://tobaccocontrol.bmj.com/content/29/e1/e152/F1)

Figure 1 
IQOS charger, device and cleaning brush (A) and HeatSticks (B).

## IQOS store experience

As of December 2019, two shopping mall-based IQOS flagship stores, seven mobile stores that were generally located in convenience store parking lots and six pop-up stores (‘IQOS Corners’) located inside convenience stores were open in and around the city of Atlanta (figure 2). Each of these locations features employees who can provide personal guided trials and have both the devices and, except for IQOS Corners, HeatSticks available for purchase. In addition, HeatSticks are being sold at 385 retail points, such as convenience stores (eg, RaceTrac), grocery stores (eg, Kroger) and pharmacies (eg, Walgreens). To get into the IQOS flagship stores or mobile locations, shoppers need to have their driver’s licence scanned by an employee at the door. If the shopper has already completed a profile with PM USA, it is retrieved immediately. Then, the shoppers are asked if they are cigarette smokers. Shoppers who state they are not cigarette smokers are permitted into the store but are not allowed to sample HeatSticks or to purchase IQOS devices or HeatSticks.

![Figure 2](http://tobaccocontrol.bmj.com/https://tobaccocontrol.bmj.com/content/tobaccocontrol/29/e1/e152/F2.medium.gif)

[Figure 2](http://tobaccocontrol.bmj.com/content/29/e1/e152/F2)

Figure 2 
Exterior of first (A) and second (B) IQOS retail locations in Georgia malls; mobile location in Atlanta, Georgia (C); IQOS corner inside a gas station in an Atlanta suburb (D).

The high-tech design of the store features modern, minimalistic decor with natural-coloured wooden tables (figure 3). Consistent with IQOS stores in other countries,2 3 it does not look like a ‘tobacco’ shop, but more like a place to buy high-tech devices. Advertisements on the walls show the product and feature happy, young adults. The advertisements, products and website include a current Surgeon General warning and, in a larger size, the warning about nicotine mandated for electronic nicotine devices (figure 3).

![Figure 3](http://tobaccocontrol.bmj.com/https://tobaccocontrol.bmj.com/content/tobaccocontrol/29/e1/e152/F3.medium.gif)

[Figure 3](http://tobaccocontrol.bmj.com/content/29/e1/e152/F3)

Figure 3 
Display and advertisements from inside the IQOS mobile unit (A). Advertisement for IQOS featured inside mobile unit and retail stores (B).

### Device and personal trial

For $1.00, shoppers who indicate that they smoke cigarettes can participate in a ‘personal IQOS trial’ in a separate room, visible from inside through large glass doors. The room is adorned with couches, display shelves with brightly coloured IQOS cases and tobacco-scented diffusers. Trial devices are stored in what the employees referred to as ‘bento boxes’ on tables. Employees provide customers step-by-step instructions on how to load the HeatStick into the IQOS, power up the device and smoke. Employees smoke IQOS alongside the customer, engaging in conversation and discussing the taste and feel of IQOS aerosol compared with cigarette smoke. Conversations between the employee and the customer focus on the experience of using IQOS; during our observations, employees avoided making claims about any health benefits of IQOS compared with cigarettes, though one did comment on the potential ‘social benefits’ of the device, such as not smelling like cigarette smoke. When the product has been consumed, employees show how to dispose of the used HeatStick in the IQOS disposal tray (not called an ‘ashtray’ because the IQOS ‘produces no ash’). Employees demonstrate how to use specially designed brushes to clean the IQOS after each use.

### Price and promotions

At the stores visited in Atlanta, the device sells for $100, and 10 packs of HeatSticks (each individual pack contains 20 HeatSticks, which makes 10 packs equivalent to a carton of cigarettes) sell for $55. This pricing is almost identical to costs reported in South Korea.2 However, with a bundle discount for purchasing them both and for having a profile with PM USA, the total cost is reduced to $87.12 ($80 for the device and HeatSticks and $7.12 in tax). Currently, IQOS offers a refer-a-friend programme for $20 off purchases for both the customer and the friend. Employees at the mall locations also mentioned the possibility to earn rewards that can be redeemed for purchasing IQOS products, including colourful cases and tips used to customise devices.

Once customers purchase a device, they are asked to complete a profile questionnaire (indicating interests such as art, fashion, television, cooking and sports) to better match them with an IQOS expert who can meet with the customer and help troubleshoot or replace the device, as well as treat customers to ‘drinks or appetisers’.

## getiqos.com website

A getiqos.com website was launched by PM USA in August 2019.2–4 In order to gain access to most parts of this website, a shopper must register for an account, self-certify that they are a current cigarette smoker 21 years old or older (by providing their name, address and driver’s license number), and answer some questions about tobacco use. Then, they must correctly answer questions about themselves (eg, prior addresses and past lenders) to confirm their identity. Once granted access to the password-protected website, the shopper is able to read information about IQOS and watch instructional videos about IQOS, access an IQOS store and retail partner map locator, participate in the refer-a-friend programme, schedule an appointment for a personal IQOS trial or service and support for device issues, learn about and access IQOS care, register an IQOS device and order IQOS products. Through the ‘Shop IQOS’ portal, shoppers (at present, only those with a Georgia street address) can order the IQOS device kit, the individual components of the kit and accessories for home delivery. Delivery is free on orders over $25, and a signature is not required. HeatSticks are not available for online purchase, and the IQOS bundle (device plus HeatSticks) can be only reserved for in store pickup. The website also offers instructions for obtaining ‘expert care’ described as a ‘personal experience’ ‘customised to you […] dedicated to supporting you in switching from traditional cigarettes to the IQOS device and Marlboro HeatSticks’.5 

## Implications and conclusion

IQOS marketing and branding in the USA is mirroring techniques that have been used successfully in other countries. For example, IQOS store and website designs and communications from the employees emphasise the ‘clean’ and ‘high-tech’ aspects of IQOS, compared with cigarettes.2 3 6–8 Additionally, IQOS locations in Georgia have promoted personalised trials, technical assistance and opportunities to socialise with IQOS representatives.2 3 

In light of the recent outbreak of vaping-related lung injury and the FDA’s recommendations against using electronic cigarettes,9 10 IQOS is being promoted in the media as a potential alternative not only for smoking but also for electronic cigarettes as well.11 12 For example, in October 2019, CNBC stated that, while the FDA confirms that no tobacco product is safe, IQOS is ‘in theory, less harmful’.13 If this news report is an indication of what is to come, especially as IQOS makes its planned launch across the country, it is imperative that incorrect claims made in the media about IQOS safety be addressed. Research has shown that cigarette marketing techniques, such as heavy price promotions and using attractive models in advertisements, increase the risk of smoking initiation, especially among adolescents and young adults.14–16 IQOS has used both techniques in the short time since their launch in the USA. Continued close monitoring of IQOS marketing is needed to understand the implications of IQOS’s marketing strategies on tobacco use going forward.

## Footnotes

*   Twitter @JidongHuang, @@FairmanRT

*   Contributors LP conceptualised the paper. VC, LP, SRW and ZM visited the retail locations. All authors contributed to the interpretation and write-up of the manuscript and approved the final manuscript.

*   Funding Research reported in this publication was supported in part by the National Institute of Drug Abuse of the National Institutes of Health and Food and Drug Administration Center for Tobacco Products (P50DA036128, R01DA047397-02S1), by the National Cancer Institute of the National Institutes of Health (R01CA194681-05S1), and by the Robert Wood Johnson Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Food and Drug Administration, or the Robert Wood Johnson Foundation.

*   Competing interests None declared.

*   Patient consent for publication Not required.

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

*   Data availability statement There are no data in this work.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: [http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/).

## References

1.  U.S. Food & Drug Administration. FDA permits sale of IQOS Tobacco Heating System through premarket tobacco product application pathway. (Press release), 2019. Available: [https://archive.ph/mA2Ik](https://archive.ph/mA2Ik) [Accessed Oct 2019].
    
    

2.   Kim M . Philip Morris International introduces new heat-not-burn product, IQOS, in South Korea. Tob Control 2018;27:e76–8.[doi:10.1136/tobaccocontrol-2017-053965](http://dx.doi.org/10.1136/tobaccocontrol-2017-053965) 
    
    [FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjk6IjI3L2UxL2U3NiI7czo0OiJhdG9tIjtzOjMxOiIvdG9iYWNjb2NvbnRyb2wvMjkvZTEvZTE1Mi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

3.   Mathers A , Schwartz R , O’Connor S , et al . Marketing IQOS in a dark market. Tob Control 2019;28:237–8.[doi:10.1136/tobaccocontrol-2017-054216](http://dx.doi.org/10.1136/tobaccocontrol-2017-054216) 
    
    [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjI4LzIvMjM3IjtzOjQ6ImF0b20iO3M6MzE6Ii90b2JhY2NvY29udHJvbC8yOS9lMS9lMTUyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

4.   Bar-Zeev Y , Levine H , Rubinstein G , et al . IQOS point-of-sale marketing strategies in Israel: a pilot study. Isr J Health Policy Res 2019;8:11. [doi:10.1186/s13584-018-0277-1](http://dx.doi.org/10.1186/s13584-018-0277-1) 
    
    

5.  Philip Morris USA Inc. IQOS, 2019. Available: [https://archive.ph/K1sQg](https://archive.ph/K1sQg) [Accessed Oct 2019].
    
    

6.   Hair EC , Bennett M , Sheen E , et al . Examining perceptions about IQOS heated tobacco product: consumer studies in Japan and Switzerland. Tob Control 2018;27:s70–3.[doi:10.1136/tobaccocontrol-2018-054322](http://dx.doi.org/10.1136/tobaccocontrol-2018-054322) 
    
    [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjE0OiIyNy9TdXBwbF8xL3M3MCI7czo0OiJhdG9tIjtzOjMxOiIvdG9iYWNjb2NvbnRyb2wvMjkvZTEvZTE1Mi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

7.   Rosen LJ , Kislev S . IQOS campaign in Israel. Tob Control 2018;27:s78–81.[doi:10.1136/tobaccocontrol-2018-054619](http://dx.doi.org/10.1136/tobaccocontrol-2018-054619) 
    
    [FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjE0OiIyNy9TdXBwbF8xL3M3OCI7czo0OiJhdG9tIjtzOjMxOiIvdG9iYWNjb2NvbnRyb2wvMjkvZTEvZTE1Mi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

8.   Hejlová D , Schneiderová S , Klabíková Rábová T , et al . Analysis of presumed IQOS influencer marketing on Instagram in the Czech Republic in 2018–2019. Adiktologie 2019;19:7–15.
    
    

9.  Centers for Disease Control and Prevention. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products, 2019. Available: [https://archive.ph/kcZCA](https://archive.ph/kcZCA) [Accessed Oct 2019].
    
    

10.  Ghinai I , Pray IW , Navon L , et al . E-cigarette product use, or vaping, among persons with associated lung iInjury - Illinois and Wisconsin, April-September 2019. MMWR Morb Mortal Wkly Rep 2019;68:865–9.[doi:10.15585/mmwr.mm6839e2](http://dx.doi.org/10.15585/mmwr.mm6839e2) 
    
    

11.  Lee J . It's not vaping: why IQOS could boost Altria and Philip Morris. The Motley Fool, 2019. Available: [https://archive.ph/uDBJw](https://archive.ph/uDBJw) [Accessed Oct 2019].
    
    

12.  Maloney J , Prang A . Philip Morris sees a bright side to vaping fears, 2019. Available: [https://archive.ph/CYTO4](https://archive.ph/CYTO4) [Accessed Oct 2019].
    
    

13.  LaVito A . Altria launches IQOS tobacco device in US, and the timing couldn't be better. In. Health and Science: CNBC, 2019. Available: [https://archive.ph/l4E4k](https://archive.ph/l4E4k) [Accessed Oct 2019].
    
    

14.  Paynter J , Edwards R . The impact of tobacco promotion at the point of sale: a systematic review. Nicotine Tob Res 2009;11:25–35.[doi:10.1093/ntr/ntn002](http://dx.doi.org/10.1093/ntr/ntn002) 
    
    [CrossRef](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=10.1093/ntr/ntn002&link_type=DOI) 
    
    [PubMed](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=19246438&link_type=MED&atom=%2Ftobaccocontrol%2F29%2Fe1%2Fe152.atom) 
    
    [Web of Science](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=000264188900004&link_type=ISI) 

15.  Forster JL , Widome R , Bernat DH . Policy interventions and surveillance as strategies to prevent tobacco use in adolescents and young adults. Am J Prev Med 2007;33:S335–9.[doi:10.1016/j.amepre.2007.09.014](http://dx.doi.org/10.1016/j.amepre.2007.09.014) 
    
    [CrossRef](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=10.1016/j.amepre.2007.09.014&link_type=DOI) 
    
    [PubMed](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=18021908&link_type=MED&atom=%2Ftobaccocontrol%2F29%2Fe1%2Fe152.atom) 

16.  Pollay RW . Targeting youth and concerned smokers: evidence from Canadian tobacco industry documents. Tob Control 2000;9:136–47.[doi:10.1136/tc.9.2.136](http://dx.doi.org/10.1136/tc.9.2.136) 
    
    [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjc6IjkvMi8xMzYiO3M6NDoiYXRvbSI7czozMToiL3RvYmFjY29jb250cm9sLzI5L2UxL2UxNTIuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)