Perceptions and intentions regarding IQOS among current US adults who use cigarettes and/or electronic nicotine delivery systems

Introduction: IQOS was sold in the US in 2019-2021 and will likely return in 2024. It is important to anticipate IQOS' market penetration; thus, this study examined US adults' prior awareness and perceptions, intentions to try and reactions to an IQOS reduced-risk exposure statement.

Methods: 61 adults from three US cities were recruited to represent four tobacco use subgroups: current cigarette and never electronic nicotine delivery systems (ENDS) use; current cigarette and discontinued ENDS use; current cigarette and ENDS use; and former cigarette use and switched to ENDS. Participants were shown IQOS marketing material and probed about IQOS awareness, knowledge, perceptions, use intentions and reactions to a reduced exposure statement. Analysis used a hybrid inductive/deductive qualitative approach.

Results: Participants reported low awareness and knowledge of IQOS and uncertainty about its functionality and health effects. Other impressions varied by subgroup. People who currently smoked but never tried ENDS reacted mostly negatively to IQOS; people who had switched to ENDS were disinterested in returning to 'real tobacco' use; people who currently used cigarettes and ENDS were curious but had mixed feelings; and people who had rejected ENDS exhibited the greatest interest but were concerned about perceived cost. Reactions to the reduced exposure statement were mixed; some groups viewed it as a meaningful endorsement of harm reduction benefits while others were sceptical.

Conclusions: Across tobacco use groups, there was varied interest and inclination to try IQOS and thus varied potential use as a complete substitute for cigarettes.