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IQOS marketing strategies in the USA before and after US FDA modified risk tobacco product authorisation
  1. Carla J Berg1,2,
  2. Katelyn F Romm1,
  3. Yael Bar-Zeev3,
  4. Lorien C Abroms1,2,
  5. Katharina Klinkhammer1,
  6. Christina N Wysota1,
  7. Amal Khayat3,
  8. David A Broniatowski4,
  9. Hagai Levine3
  1. 1 Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
  2. 2 GW Cancer Center, The George Washington University, Washington, DC, USA
  3. 3 Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem and Hadassah Medical Organization, Jerusalem, Israel
  4. 4 Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, The George Washington University, Washington, DC, USA
  1. Correspondence to Dr Carla J Berg, Washington, District of Columbia, USA; carlaberg{at}


Introduction Given that the US Food and Drug Administration (FDA) authorised reduced exposure messaging to be used in IQOS marketing, we examined: (1) IQOS ad content; (2) advertising media channels and (3) changes in advertising efforts over time.

Methods We conducted a mixed-methods study regarding IQOS ad content (headlines, themes, images), ad occurrence characteristics (including content, media channels and adspend) in the USA from August 2019 to April 2021 using Numerator advertising/marketing data.

Results Across 24 unique ads and 591 occurrences (84.6% online, 8.0% print, 7.4% mobile), there was $4 902 110 total adspend (98.9% allocated to print). Across unique ads, occurrences and adspend, prominent themes included ‘real tobacco’ (45.8%, 47.4%, 30.1%, respectively), less odour/ash (29.2%, 21.0%, 29.9%) and switching from cigarettes (25.0%, 19.5%, 69.4%), and images mainly featured the product alone (58.2%, 61.4%, 99.5%) or with women (25.0%, 19.1%, 0.3%). Per occurrences and adspend, the most prominent media channel themes (eg, magazine/website topics) were technology (19.3%, 10.6%), women’s fashion (18.1%, 26.2%), weather/news (9.0%, 15.3%) and entertainment/pop culture/gaming (8.5%, 23.1%). Ad themes appearing only post-FDA authorisation included switching from traditional cigarettes, same-day/home-delivery, convenience (eg, use indoors), reduced exposure to some dangerous substances, science/research and distinction from e-cigarettes. Overall adspend per occurrence increased postauthorisation (p=0.016); the highest adspend per unique ad (69.3% of total) focused on ads featuring reduced exposure.

Conclusions Regulatory efforts must be informed by ongoing surveillance of IQOS marketing efforts and its impacts, particularly how specific consumer subgroups (eg, tobacco non-users, women, young people) are impacted by marketing exposure.

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

Data availability statement

Data are available on reasonable request. Restricted data available on request.

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Data availability statement

Data are available on reasonable request. Restricted data available on request.

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  • Twitter @RommKatelyn, @yaelbarzeev

  • Contributors All authors contributed to the conceptualisation of the study. CB and KR led the analyses. CB, HL and YB-Z obtained grant funding, provided resources and oversaw project administration. CB and KR led the writing of the original manuscript and the revised manuscript. All coauthors reviewed the manuscript. All authors confirm their approval of the submitted manuscript.

  • Funding This research was supported by the National Cancer Institute (R01CA239178-01A1; MPIs: Berg, Levine) and by the Israel Lung and Tuberculosis Association (MPIs: Bar-Zeev, Levine). CB is also supported by other NIH funding, specifically the US National Cancer Institute (R01CA179422-01; PI: Berg; R01CA215155-01A1; PI: Berg), the US Fogarty International Center/National Institutes of Health (NIH) (1R01TW010664-01; MPIs: Berg, Kegler) and the National Institute of Environmental Health Sciences/Fogarty (D43ES030927-01; MPIs: Berg, Marsit, Sturua).

  • Competing interests YB-Z has received fees for lectures from Pfizer Ltd, Novartis NCH and GSK Consumer Health (distributors of smoking cessation pharmacotherapy in Israel) in the past (2012 to July 2019). HL had received fees for lectures from Pfizer Israel Ltd (distributor of a smoking cessation pharmacotherapy in Israel) in 2017. LA receives royalties for the sale of Text2Quit and is a shareholder in Welltok, Inc.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.