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PMI’s IQOS and cigarette ads in Israeli media: a content analysis across regulatory periods and target population subgroups
  1. Amal Khayat1,
  2. Carla J Berg2,
  3. Hagai Levine1,
  4. Maya Rodnay1,
  5. Lorien Abroms2,
  6. Katelyn F Romm3,4,
  7. Zongshuan Duan2,
  8. Yael Bar-Zeev1
  1. 1Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  2. 2Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
  3. 3Department of Pediatrics, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
  4. 4TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
  1. Correspondence to Amal Khayat, Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem 9112102, Israel; amal.khayat{at}


Background IQOS, manufactured by Philip Morris International (PMI), is the highest selling heated tobacco product globally. IQOS went through several regulatory changes in Israel: from no oversight to minimal tobacco legislation, to progressive legislation that included a partial advertisement ban (exempting print media) and plain packaging. We examined how PMI’s advertising messages changed during these regulatory periods for both IQOS and cigarettes.

Methods Content analysis of PMI’s IQOS and cigarette ads was performed using a predefined framework. Ad characteristics included regulatory period, target population, setting, product presentation, age and use restrictions, retail accessibility, additional detail cues (eg, QR code) and promotions. Ad themes included product features, legislation-related elements, social norms and comparative claims. Comparisons between IQOS and cigarette ads, and across regulatory periods, were examined using χ2 test or Fisher’s exact test.

Results The dataset included 125 IQOS ads and 71 cigarette ads. IQOS ads featured more age restrictions, retail accessibility and additional detail cues, compared with cigarette ads (93.6% vs 16.9%; 56.0% vs 0.0%; and 95.2% vs 33.8%, p<0.001 for all). Cigarette ads featured mostly price promotions (52.1% vs 10.1% of IQOS ads, p<0.001). The main ad themes were technology for IQOS (85.6%) and quality for cigarettes (50.7%). In later (vs earlier) restrictive regulatory periods, IQOS ads featured more direct comparisons to cigarettes, QR codes and indoor settings, and did not feature product packaging.

Conclusions IQOS advertisement content shifted as more restrictions went into effect, with several elements used to circumvent legislation. Findings from this study point to the necessity of a complete advertisement ban and ongoing marketing surveillance.

  • Advertising and Promotion
  • Electronic nicotine delivery devices
  • Surveillance and monitoring

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @AmalKhayat5, @lorien_a, @yaelbarzeev

  • Contributors YB-Z, CJB, HL and AK designed the study. AK analysed the data under the guidance of YB-Z. AK and YB-Z wrote the draft manuscript. 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, have access to the data and control 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.