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IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis
  1. Amal Khayat1,
  2. Hagai Levine1,
  3. Carla J Berg2,
  4. Michal Shauly-Aharonov3,
  5. Orly Manor1,
  6. Lorien Abroms2,
  7. Katelyn F Romm4,5,
  8. Christina N Wysota2,
  9. Yael Bar-Zeev1
  1. 1 Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  2. 2 Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
  3. 3 Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
  4. 4 Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  5. 5 TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  1. Correspondence to Amal Khayat, Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem; 9112102, Israel; amal.khayat{at}


Background Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International’s (PMI) IQOS and cigarette advertisements.

Methods Weekly number of ads and weekly adspend of PMI’s IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regressions over time, across regulatory periods and in relation to subpopulations (general public, Arab, Russian and Ultra-Orthodox), from 25 December 2016 to 4 August 2020. Exponentiated coefficients (a value >1 indicates an increase) and 95% CIs are reported.

Results The average weekly number of ads and the average weekly adspend of IQOS were higher than cigarettes (42.22 vs 26.76 ads/week and 59 409 vs 45 613 new Israeli shekels/week; p<0.001 for both) during the study period, with exclusive IQOS advertisements during market penetration (December 2016 to May 2017). Variation in both outcomes was observed with regard to regulatory decisions. After the advertisement ban, there was a significant decrease in the weekly number of ads (IQOS: ß=0.04, 95% CI 0.002 to 0.20; cigarettes: ß=0.05, 95% CI 0.01 to 0.15) and weekly adspend (IQOS: ß=0.15, 95% CI 0.07 to 0.29; cigarettes: ß=0.31, 95% CI 0.17 to 0.53) for both products. The Ultra-Orthodox had significantly higher average weekly ads compared with the Arab population (IQOS: 0.67 vs 0.07; cigarettes: 2.74 vs 0.13; p=0.02 for both) but lower adspend.

Conclusions IQOS and cigarette advertisements varied over time and appeared to have been impacted by regulatory changes. PMI invested more in IQOS advertisements than in cigarettes, with a partial advertisement ban decreasing both products’ advertisements. PMI might be targeting the Ultra-Orthodox Jewish population which has a low smoking rate. Further research and surveillance are needed to better understand targeting strategies in order to inform tobacco control policy.

  • Advertising and Promotion
  • Media
  • Electronic nicotine delivery devices

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request from the corresponding author.

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  • Twitter @AmalKhayat5, @yaelbarzeev

  • Contributors YB-Z, CJB, HL and AK designed the study. MS-A and OM contributed to the study design and methodology. AK analysed the data under the guidance of MS-A and YB-Z, and wrote the draft manuscript under the guidance of YB-Z. All coauthors reviewed and authorised the final manuscript. YB-Z oversaw the entire process, including the analysis and writing of the manuscript. AK and YB-Z are acting as the guarantors and accept 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 Institutes of Health (R01 1R01CA239178-01A1; MPIs: CJB, HL).

  • Competing interests YB-Z has received fees for lectures in the past (2012 to July 2019) from Pfizer, Novartis NCH and GSK Consumer Health (distributors of smoking cessation pharmacotherapy in Israel). 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.

  • 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.