King's College London

Background One of the most widely available heated tobacco products is IQOS by Philip Morris International. However, there is a lack of independent research exploring IQOS initiation and subsequent use among smokers and ex-smokers.

Aims To (1) explore the reasons why smokers and ex-smokers use and continue/discontinue IQOS and (2) consider implications for future research and policy.

Participants Adult (18+) current (n=22) and ex-users (n=8) of IQOS who either currently smoked or quit smoking in the last 2 years.

Methods Qualitative interview study in London, UK.

Results Six main factors influenced initiation and use of IQOS: (1) Health—wanting to reduce/quit smoking and perceptions of reduced harm (while understanding IQOS was not risk-free). Branded packaging, absence of pictorial warnings and physical health improvements conveyed reduced harm. (2) Financial—including high start-up costs, but cheaper ongoing costs than smoking. (3) Physical—mixed views on enjoyment and satisfaction. Sensory experiences influenced use including discreetness, cleanliness, reduced smell and tactile similarities relative to combustible cigarettes. (4) Practical—issues of accessibility, shortcomings with maintenance/operation limited ongoing use, whereas use in smoke-free places increased use. (5) Psychological—similarities in rituals and routines, although new practices developed to charge and clean; some liked trailblazing new technology. (6) Social—improved social interactions from using IQOS instead of smoking, but with more limited shared social experiences for some.

Conclusion For some, IQOS facilitated smoking substitution. Factors such as packaging, labelling, risk communication, price and smoke-free policies appear to influence initiation and use.