Article Text

Factors that influence smokers’ and ex-smokers’ use of IQOS: a qualitative study of IQOS users and ex-users in the UK
  1. Charlotte N E Tompkins1,
  2. Annabel Burnley1,
  3. Ann McNeill1,2,
  4. Sara C Hitchman1
  1. 1 Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  2. 2 SPECTRUM Consortium, UK – Shaping Public Health Policies To Reduce Inequalities and Harm, UK
  1. Correspondence to Dr Sara C Hitchman, UK Centre for Tobacco Control Studies, National Addiction Centre, Institute of Psychiatry, King’s College London, London WC2R 2LS, UK; sara.hitchman{at}


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.

  • tobacco industry
  • harm reduction
  • non-cigarette tobacco products

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Twitter @kingsNRG

  • Correction notice This article has been corrected since it was published Online First. Section on disclaimer has now been updated.

  • Contributors CNET and SCH conceived and designed the study and interview topic guide, conducted the expert and user consultation, reviewed the qualitative findings and drafted the final paper. CNET led the recruitment, interviewed all participants and conducted the analyses. AB helped with recruitment, background research and data entry/tables. AMcN provided input on the study design, topic guide, findings and paper. All authors read and provided comments on the final manuscript, and contributed to writing.

  • Funding Cancer Research UK Tobacco Advisory Group (CRUK C51836/A25751) provided financial support for the study.

  • Disclaimer Professor McNeill is a National Institute for Health Research (NIHR) Senior Investigator. The views expressed in this article are those of the authors and not necessarily those of the NIHR, or the Department of Health and Social Care.

  • Competing interests CNET has previously received salary support from Camurus AB and Mundipharma International Ltd on studies relating to the treatment of opioid dependence.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from King’s College London (KCL) Research Ethics Committee (reference LRS-17/18-5765).

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

  • Data availability statement No data are available.

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.