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Impact of IQOS modified risk messaging on physicians’ product perceptions and recommendations
  1. Olivia A Wackowski1,
  2. Michael B Steinberg1,2,
  3. Cristine D Delnevo1
  1. 1Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
  2. 2Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
  1. Correspondence to Dr Olivia A Wackowski, Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, NJ 08901, USA; olivia.wackowski{at}

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The US Food and Drug Administration (FDA) has developed a pathway by which tobacco companies can request products be authorised as ‘modified risk tobacco products’ (MRTPs) and make claims about reduced risks or constituent exposures.1 MRTP claims have been authorised for only four products including IQOS.1 2 While IQOS ads with authorised MRTP claims are targeted at people who smoke cigarettes, we examined whether such ads and claims may also impact physicians, who are an important source of patient information regarding tobacco harms.3 4


Data come from a broader US survey of a national sample of board-certified physicians about their tobacco-related beliefs and practices.5 An IQOS experiment was embedded in the online survey version. Data were collected (May–October 2021) before US IQOS sales were halted in November 2021 because of a patent infringement ruling.6

Subjects were randomly assigned to one of three groups in which they viewed a manipulated IQOS ad that either included no MRTP message (control) or FDA-authorised MRTP message about reduced chemicals (experimental group 1 …

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  • Twitter @owackowski, @crisdelnevo

  • Contributors CDD and MBS designed and obtained funding for the parent survey study and led the implementation of the parent study. OAW led the design of the embedded IQOS experiment in the parent study and led the writing of the manuscript. MBS and CDD contributed to the review and editing of the manuscript.

  • Funding This work was supported by the National Cancer Institute (NCI) of the National Institutes of Health (under R01CA190444). Contributions by OAW were also supported by NCI (under R37CA222002). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

  • Competing interests None declared.

  • 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.