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IQOS marketing strategies at point-of-sales: a cross-sectional survey with retailers
  1. Yael Bar-Zeev1,
  2. Carla J Berg2,
  3. Amal Khayat1,
  4. Katelyn F Romm2,
  5. Chritina N Wysota2,
  6. Lorien C Abroms2,
  7. Daniel Elbaz1,
  8. Hagai Levine1
  1. 1 Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
  2. 2 Milken Institute School of Public, George Washington University, Washington, DC, USA
  1. Correspondence to Dr Yael Bar-Zeev, Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel;{at}


Background The point-of-sale (POS) is adapting to marketing restrictions, societal changes and the inclusion of new products, such as heated tobacco products (eg, Philip Morris International’s (PMI) IQOS device and HEETS sticks). We aimed to assess (1) PMI’s influences on IQOS/HEETS POS marketing and (2) the implications of the new legislation (POS display ban and plain packaging) for retailers.

Methods A cross-sectional survey of 43 IQOS/HEETS POS owners/managers in five Israeli cities assessed POS and participant characteristics, marketing strategies, attitudes towards IQOS, and POS implications of the legislation and COVID-19, including industry reactions. Bivariate analysis explored differences between POS selling of the IQOS device versus POS selling of HEETS only.

Results A higher proportion of those carrying IQOS (n=15) (vs HEETS only) had special displays (100% vs 17.9%, p<0.001) and interacted with specific IQOS salespersons (73.3% vs 28.6%, p=0.013). Common promotions were financial incentives based on HEETS sales for retailers (37.5%) and price discounts on HEETS for customers (48.7%). Most indicated positive attitudes towards IQOS (72.1%; eg, ‘less harmful’), opposition to the legislation (62.7%), limited government assistance to implement the legislation (62.8%), and industry provision of display cases and/or signage to comply with the legislation (67.4%).

Conclusion PMI uses similar tactics to promote IQOS at POS as they previously used for combustible products, including direct promotional activities with retailers, and circumvented legislation by using special displays and signage. Governments need to ban these measures and support retailers with clear practical guidance regarding the implementation of marketing restrictions at POS.

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

Data availability statement

Data are available upon reasonable request.

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Data are available upon reasonable request.

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  • Twitter @yaelbarzeev, @AmalKhayat5, @RommKatelyn

  • Contributors YB-Z, CJB, HL and LA designed this study. KFR, CW and AK contributed to study design and methodology. AK and DE contributed to data collection. YB-Z analysed the data and wrote the draft manuscript. All coauthors reviewed the final manuscript. YB-Z accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This research was supported by the National Cancer Institute (R01CA239178-01A1; MPIs: CJB, HL) and by the Israel Lung and Tuberculosis Association (MPIs: YB-Z, HL).

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

  • 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.