Article Text

Download PDFPDF
PMI’s heated tobacco products marketing claims of reduced risk and reduced exposure may entice youth to try and continue using these products
  1. Karma McKelvey1,
  2. Michael Baiocchi2,
  3. Bonnie Halpern-Felsher1
  1. 1 Pediatrics/Adolescent Medicie, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Statistics, Stanford University Stanford Prevention Research Center, Stanford, California, USA
  1. Correspondence to Dr Bonnie Halpern-Felsher, Pediatrics/Adolescent Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA; bonnieh{at}


Importance Philip Morris International (PMI) is seeking Food and Drug Administration’s (FDA) authorisation to market IQOS as a modified risk tobacco product and to make marketing claims of reduced risk and reduced exposure. Such claims may be misunderstood by youth, thereby increasing their risk for tobacco initiation.

Objective To assess youth (mean age 19.3, SD=1.7) understanding and perceptions of PMI’s proposed consumer marketing claims of reduced risk and reduced exposure, we embedded a randomised controlled experiment into a survey of 450 California youth (April to August 2018). Participants were randomised to see ‘reduced exposure’, ‘reduced risk’ or neither claim. Perceptions of IQOS-related health risks and general harm and understanding of the term ‘switching completely’ as used in PMI’s proposed claims were compared.

Results Mean expectancies to experience specific health risks did not differ by claim exposure. The reduced exposure group’s perceptions of general harm did not differ from those of controls nor from the reduced risk group. The reduced risk group had the largest proportion who perceived IQOS as moderately/less harmful (n=78, 52%); controls the largest proportion perceiving IQOS as quite/extremely harmful (n=91, 63%). While 71% of the sample understood the term ‘switch completely’ correctly as used in the reduced risk (n=194, 71%) and reduced exposure (n=206, 72%) claims, more than 1 in 4 did not.

Conclusions FDA and other regulators must use caution when considering allowing claims of reduced risk or reduced exposure to appear on retail tobacco packaging. Youth misunderstand such claims, and misperceptions of harm are known to lead to tobacco-use initiation.

  • non-cigarette tobacco products
  • packaging and labelling
  • tobacco industry

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All four authors are responsible for the information in this manuscript; and have participated in the concept, design and drafting of the submitted manuscript.

  • Funding Research reported in this paper was supported by grant number 1P50CA180890 from the National Cancer Institute and the Food and Drug Administration Centre for Tobacco Products and grant number U54 HL147127 from the National Heart, Lung, and Blood Institute and the Food and Drug Administration Centre for Tobacco Products. Additional support for KM was provided by NIH/NIDA grant 1F32DA044733-01 and grant 1111239–440-JHACT from the Stanford Maternal and Child Health Research Institute.

  • Disclaimer The funders had no role in the design or conduct of the study, including the data collection, data management, analyses, interpretation of the data, or the manuscript preparation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Due to legal restrictions on grant-funded research, and the fact that this is an ongoing longitudinal study asking youth below age 18 about illegal activity (tobacco and marijuana use) relevant data may be shared with a signed data use agreement through Dr. Bonnie Halpern-Felsher, at