Impact of FDA endorsement and modified risk versus exposure messaging in IQOS ads: a randomised factorial experiment among US and Israeli adults

Carla J. Berg; Zongshuan Duan; Yan Wang; James F. Thrasher; Yael Bar-Zeev; Lorien C. Abroms; Katelyn F. Romm; Amal Khayat; Hagai Levine

doi:10.1136/tc-2022-057639

Impact of FDA endorsement and modified risk versus exposure messaging in IQOS ads: a randomised factorial experiment among US and Israeli adults

Carla J. Berg^*, Zongshuan Duan, Yan Wang, James F. Thrasher, Yael Bar-Zeev, Lorien C. Abroms, Katelyn F. Romm, Amal Khayat, Hagai Levine

^*Corresponding author for this work

Department of Social Medicine

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background IQOS was the first heated tobacco product to receive Food and Drug Administration (FDA) authorisation for € reduced exposure' marketing claims, which has been exploited globally. Methods In November-December 2021, we conducted a survey-based 3×3 factorial experiment among US (n=1128) and Israeli adults (n=1094). We presented: (1) reduced exposure, reduced risk and control messaging and (2) 2 variations of FDA endorsement and control messaging. Each participant was randomly assigned to evaluate 2 ads (displayed on different ad imagery), then completed assessments of perceived relative harm, exposure and disease risk and likelihood of personally trying or suggesting IQOS to smokers. Ordinal logistic regression examined messaging conditions and their interactions, on the 5 outcomes, respectively, adjusting for covariates. Results Control (vs reduced exposure) messaging resulted in higher perceived relative harm (adjusted OR (aOR)=1.29, 95% CI=1.12 to 1.48), exposure (aOR=1.34, 95% CI=1.17 to 1.54) and disease risk (aOR=1.23; 95% CI=1.08 to 1.40), and lower likelihood of suggesting IQOS to smokers (aOR=0.85; 95% CI=0.74 to 0.97). Reduced risk (vs exposure) messaging resulted in lower perceived relative harm (aOR=0.86; 95% CI=0.75 to 0.99). One FDA endorsement message ( € IQOS (completed) the US FDA examination of tobacco products. FDA concluded that IQOS is a better choice for adult smokers') was associated with greater likelihood of suggesting IQOS to smokers, relative to control (aOR=1.19; 95% CI=1.04 to 1.37). No interactions between risk/exposure messaging and FDA endorsement messaging were found. Additionally, Israeli participants, cigarette users and men perceived lower relative harm and exposure and greater likelihood of trying or suggesting IQOS to smokers. Conclusions Regulators must monitor direct and indirect advertising content of modified risk tobacco product-authorised products and prevent potentially harmful misinterpretations.

Original language	English
Pages (from-to)	69-77
Number of pages	9
Journal	Tobacco Control
Volume	33
Issue number	e1
Early online date	25 Nov 2022
DOIs	https://doi.org/10.1136/tc-2022-057639
State	Published - 19 Mar 2024

Bibliographical note

Funding Information:
This work was supported by the US National Cancer Institute (R01CA239178-01A1; Multiple Principal Investigators [MPIs]: CJB, HL). CJB is also supported by other US National Institutes of Health funding, including the National Cancer Institute (R01CA215155-01A1; Principal Investigator [PI]: CJB; R01CA179422-01; PI: CJB), the Fogarty International Center (R01TW010664-01; MPIs: CJB, Kegler), the National Institute of Environmental Health Sciences/Fogarty (D43ES030927-01; MPIs: CJB, Caudle, Sturua) and the National Institute on Drug Abuse (R01DA054751-01A1; MPIs: CJB, Cavazos-Rehg). KFR is supported by the National Institute on Drug Abuse (F32DA055388-01; PI: KFR; R25DA054015; MPIs: Obasi, Reitzel), the Oklahoma Tobacco Settlement Endowment Trust (TSET) contract #R22-03, and the National Cancer Institute grant awarded to the Stephenson Cancer Center (P30CA225520).

Publisher Copyright:
© 2022 Author(s). Published by BMJ.

Keywords

advertising and promotion
harm reduction
media
non-cigarette tobacco products
packaging and labelling

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10.1136/tc-2022-057639

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title = "Impact of FDA endorsement and modified risk versus exposure messaging in IQOS ads: a randomised factorial experiment among US and Israeli adults",

abstract = "Background IQOS was the first heated tobacco product to receive Food and Drug Administration (FDA) authorisation for € reduced exposure' marketing claims, which has been exploited globally. Methods In November-December 2021, we conducted a survey-based 3×3 factorial experiment among US (n=1128) and Israeli adults (n=1094). We presented: (1) reduced exposure, reduced risk and control messaging and (2) 2 variations of FDA endorsement and control messaging. Each participant was randomly assigned to evaluate 2 ads (displayed on different ad imagery), then completed assessments of perceived relative harm, exposure and disease risk and likelihood of personally trying or suggesting IQOS to smokers. Ordinal logistic regression examined messaging conditions and their interactions, on the 5 outcomes, respectively, adjusting for covariates. Results Control (vs reduced exposure) messaging resulted in higher perceived relative harm (adjusted OR (aOR)=1.29, 95% CI=1.12 to 1.48), exposure (aOR=1.34, 95% CI=1.17 to 1.54) and disease risk (aOR=1.23; 95% CI=1.08 to 1.40), and lower likelihood of suggesting IQOS to smokers (aOR=0.85; 95% CI=0.74 to 0.97). Reduced risk (vs exposure) messaging resulted in lower perceived relative harm (aOR=0.86; 95% CI=0.75 to 0.99). One FDA endorsement message ( € IQOS (completed) the US FDA examination of tobacco products. FDA concluded that IQOS is a better choice for adult smokers') was associated with greater likelihood of suggesting IQOS to smokers, relative to control (aOR=1.19; 95% CI=1.04 to 1.37). No interactions between risk/exposure messaging and FDA endorsement messaging were found. Additionally, Israeli participants, cigarette users and men perceived lower relative harm and exposure and greater likelihood of trying or suggesting IQOS to smokers. Conclusions Regulators must monitor direct and indirect advertising content of modified risk tobacco product-authorised products and prevent potentially harmful misinterpretations.",

keywords = "advertising and promotion, harm reduction, media, non-cigarette tobacco products, packaging and labelling",

author = "Berg, {Carla J.} and Zongshuan Duan and Yan Wang and Thrasher, {James F.} and Yael Bar-Zeev and Abroms, {Lorien C.} and Romm, {Katelyn F.} and Amal Khayat and Hagai Levine",

note = "Publisher Copyright: {\textcopyright} 2022 Author(s). Published by BMJ.",

year = "2024",

month = mar,

day = "19",

doi = "10.1136/tc-2022-057639",

language = "אנגלית",

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T2 - a randomised factorial experiment among US and Israeli adults

AU - Berg, Carla J.

AU - Duan, Zongshuan

AU - Wang, Yan

AU - Thrasher, James F.

AU - Bar-Zeev, Yael

AU - Abroms, Lorien C.

AU - Romm, Katelyn F.

AU - Khayat, Amal

AU - Levine, Hagai

PY - 2024/3/19

Y1 - 2024/3/19

N2 - Background IQOS was the first heated tobacco product to receive Food and Drug Administration (FDA) authorisation for € reduced exposure' marketing claims, which has been exploited globally. Methods In November-December 2021, we conducted a survey-based 3×3 factorial experiment among US (n=1128) and Israeli adults (n=1094). We presented: (1) reduced exposure, reduced risk and control messaging and (2) 2 variations of FDA endorsement and control messaging. Each participant was randomly assigned to evaluate 2 ads (displayed on different ad imagery), then completed assessments of perceived relative harm, exposure and disease risk and likelihood of personally trying or suggesting IQOS to smokers. Ordinal logistic regression examined messaging conditions and their interactions, on the 5 outcomes, respectively, adjusting for covariates. Results Control (vs reduced exposure) messaging resulted in higher perceived relative harm (adjusted OR (aOR)=1.29, 95% CI=1.12 to 1.48), exposure (aOR=1.34, 95% CI=1.17 to 1.54) and disease risk (aOR=1.23; 95% CI=1.08 to 1.40), and lower likelihood of suggesting IQOS to smokers (aOR=0.85; 95% CI=0.74 to 0.97). Reduced risk (vs exposure) messaging resulted in lower perceived relative harm (aOR=0.86; 95% CI=0.75 to 0.99). One FDA endorsement message ( € IQOS (completed) the US FDA examination of tobacco products. FDA concluded that IQOS is a better choice for adult smokers') was associated with greater likelihood of suggesting IQOS to smokers, relative to control (aOR=1.19; 95% CI=1.04 to 1.37). No interactions between risk/exposure messaging and FDA endorsement messaging were found. Additionally, Israeli participants, cigarette users and men perceived lower relative harm and exposure and greater likelihood of trying or suggesting IQOS to smokers. Conclusions Regulators must monitor direct and indirect advertising content of modified risk tobacco product-authorised products and prevent potentially harmful misinterpretations.

AB - Background IQOS was the first heated tobacco product to receive Food and Drug Administration (FDA) authorisation for € reduced exposure' marketing claims, which has been exploited globally. Methods In November-December 2021, we conducted a survey-based 3×3 factorial experiment among US (n=1128) and Israeli adults (n=1094). We presented: (1) reduced exposure, reduced risk and control messaging and (2) 2 variations of FDA endorsement and control messaging. Each participant was randomly assigned to evaluate 2 ads (displayed on different ad imagery), then completed assessments of perceived relative harm, exposure and disease risk and likelihood of personally trying or suggesting IQOS to smokers. Ordinal logistic regression examined messaging conditions and their interactions, on the 5 outcomes, respectively, adjusting for covariates. Results Control (vs reduced exposure) messaging resulted in higher perceived relative harm (adjusted OR (aOR)=1.29, 95% CI=1.12 to 1.48), exposure (aOR=1.34, 95% CI=1.17 to 1.54) and disease risk (aOR=1.23; 95% CI=1.08 to 1.40), and lower likelihood of suggesting IQOS to smokers (aOR=0.85; 95% CI=0.74 to 0.97). Reduced risk (vs exposure) messaging resulted in lower perceived relative harm (aOR=0.86; 95% CI=0.75 to 0.99). One FDA endorsement message ( € IQOS (completed) the US FDA examination of tobacco products. FDA concluded that IQOS is a better choice for adult smokers') was associated with greater likelihood of suggesting IQOS to smokers, relative to control (aOR=1.19; 95% CI=1.04 to 1.37). No interactions between risk/exposure messaging and FDA endorsement messaging were found. Additionally, Israeli participants, cigarette users and men perceived lower relative harm and exposure and greater likelihood of trying or suggesting IQOS to smokers. Conclusions Regulators must monitor direct and indirect advertising content of modified risk tobacco product-authorised products and prevent potentially harmful misinterpretations.

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Impact of FDA endorsement and modified risk versus exposure messaging in IQOS ads: a randomised factorial experiment among US and Israeli adults

Abstract

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