Open Access

How do Risk Perceptions Drive Smokers to Completely Switch to a Smoke-Free Tobacco Product (IQOS™)? A Four-Country Cohort Study

Karina Fischer
Karina Fischer
, 
Steve Roulet
Steve Roulet
, 
Andreea Surducan
Andreea Surducan
, 
Mario Colombo
Mario Colombo
 and 
Pierpaolo Magnani
Pierpaolo Magnani
   | Jun 13, 2023
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Published Online: Jun 13, 2023
Page range: 50 - 64
Received: Dec 13, 2022
Accepted: Apr 06, 2023
DOI: https://doi.org/10.2478/cttr-2023-0007
© 2023 Karina Fischer et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Figure 1.

Patterns of TP use at week 48 by country and number of RF and/or RH indications. Participants of PMI’s open online IQOS™ user consumer cohorts in Japan (N = 6257, ≥ 21 y), Italy (N = 8173, ≥ 19 y), Germany (N = 8474, ≥ 19 y), and Russia (N = 7231, ≥ 19 y) were followed-up between 2016 and 2020 during their first 48 weeks in the cohort. Abbreviations: CC: manufactured and hand-rolled cigarettes; HTP: heated TP; Other TP use: participants with no TP use in the past 7 days and/or no intention to use TPs in future; PMI: Philip Morris International; RF: perceived reduced formation of harmful chemicals; RH: perceived reduced risk of harm; TP: tobacco product.
Patterns of TP use at week 48 by country and number of RF and/or RH indications. Participants of PMI’s open online IQOS™ user consumer cohorts in Japan (N = 6257, ≥ 21 y), Italy (N = 8173, ≥ 19 y), Germany (N = 8474, ≥ 19 y), and Russia (N = 7231, ≥ 19 y) were followed-up between 2016 and 2020 during their first 48 weeks in the cohort. Abbreviations: CC: manufactured and hand-rolled cigarettes; HTP: heated TP; Other TP use: participants with no TP use in the past 7 days and/or no intention to use TPs in future; PMI: Philip Morris International; RF: perceived reduced formation of harmful chemicals; RH: perceived reduced risk of harm; TP: tobacco product.

Number of RF and/or RH indications and the likelihood of exclusive IQOS™ or HTP use.

Number of RF and/or RH indications Japan (N = 6257) Italy (N = 8173) Germany (N = 8474) Russia (N = 7231)
Exclusive HTP Exclusive IQOS™ Exclusive IQOS™ Exclusive IQOS™ Exclusive IQOS™
OR (95% CI) OR (95% CI) (n) OR (95% CI) (n) OR (95% CI) (n) OR (95% CI) (n)
0 Reference (1.0) Reference (1.0) 1552 Reference (1.0) 5032 Reference (1.0) 1827 Reference (1.0) 1887
1 1.65 (1.44–1.89) 1.12 (0.98–1.27) 1 904 1.48 (1.25–1.76) 538 1.16 (1.03–1.31) 2 1129 1.73 (1.54–1.95) 1189
2–5 2.28 (2.08–2.52) 1.35 (1.23–1.48) 1964 2.23 (1.98–2.51) 1260 1.59 (1.47–1.72) 2639 2.28 (2.08–2.49) 2342
6–10 3.38 (2.94–3.89) 1.47 (1.31–1.66) 1138 2.55 (2.22–2.93) 991 2.36 (2.14–2.61) 1858 2.74 (2.42–3.10) 1266
11–13 4.87 (4.00–5.94) 1.89 (1.62–2.21) 699 3.35 (2.61–4.29) 352 3.48 (3.00–4.03) 1021 3.05 (2.51–3.71) 547

Baseline participant characteristics of IQOS™ user consumer cohort samples in Japan, Italy, Germany, and Russia.

Number (n) and percentage (% [95% CI]) or mean (SD [range])
Japan (N = 6257) Italy (N = 8173) Germany (N = 8474) Russia (N = 7231) P
Sex (n [%])
  Male 4784 (76%) 5651 (69%) 4969 (59%) 4820 (67%) < 0.0001
  Female 1473 (24%) 2522 (31%) 3505 (41%) 2411 (33%)
Age (n [%])
  LAS–29 284 (5%) 1382 (17%) 1191 (14%) 1978 (27%) < 0.0001
  30–39 1251 (20%) 2275 (28%) 2180 (26%) 3055 (42%)
  40–49 2268 (36%) 2493 (31%) 2052 (24%) 1528 (21%)
  50+ 2454 (39%) 2023 (25%) 3051 (36%) 670 (9%)
  Mean (SD [range]) 46.6 (9.9 [21–85]) 42.7 (11.5 [19–85]) 43.8 (12.2 [19–85]) 36.0 (9.5 [19–85]) < 0.0001
Education1 (n [%])
  Elementary School/Junior High School (1) 245 (4%) 683 (9%) 2409 (31%) 6 (0.1%) < 0.0001
  High School/Old Junior High School (2) 2161 (37%) 3344 (42%) 1202 (16%) 340 (5%)
  Junior College/Higher Professional School (3) 1138 (19%) 1376 (17%) 857 (11%) 1077 (15%)
  College/University/Graduate School (4) 2235 (38%) 2539 (32%) 2338 (30%) 5538 (79%)
  None of these (5) 73 (1%) 0 (0.0%) 960 (12%) 32 (0.5%)
Living Situation (n [%])
  Living at home with parents 898 (15%) 1116 (14%) 304 (4%) 529 (8%) < 0.0001
  Living with friends/housemates 91 (2%) 159 (2%) 302 (4%) 220 (3%)
  Living by yourself 1019 (17%) 1043 (14%) 1503 (19%) 988 (15%)
  Living with partner/spouse (no child) 979 (17%) 1867 (24%) 2609 (33%) 1899 (30%)
  Single parent living with children 192 (3%) 267 (3%) 267 (3%) 166 (3%)
  Family with children living at home 2328 (39%) 2741 (36%) 2183 (28%) 1735 (27%)
  Empty nesters (children have left home) 272 (5%) 398 (5%) 785 (10%) 564 (9%)
  Others 117 (2%) 109 (32%) 175 (2%) 286 (4%)
Employment status2 (n [%])
  Housewife/Homemaker 294 (5%) N/A 174 (2%) 224 (3%) < 0.0001
  Student/Apprentice 48 (1%) N/A 533 (6%) 266 (4%)
  Retired/Pensioner 98 (2%) N/A 347 (4%) 84 (1%)
  Unemployed 163 (3%) N/A 79 (1%) 297 (4%)
  In employment/Self-employed 5017 (80%) N/A 6123 (72%) 6360 (88%)
  Other income3 (n [%]) 637 (10%) N/A 1218 (14%) 0 (0.0%)
    (1) 278 (7%) N/A 240 (5%) 868 (19%) N/A4
    (2) 659 (17%) N/A 982 (19%) 825 (18%)
    (3) 852 (22%) N/A 1245 (25%) 701 (15%)
    (4) 710 (18%) N/A 1163 (23%) 750 (16%)
    (5) 492 (13%) N/A 598 (12%) 428 (9%)
    (6) 512 (13%) N/A 834 (16%) 301 (6%)
    (7) 430 (11%) N/A – 795 (17%)
RF and/or RH mentioned during follow-up (n [%])
    No 1,552 (24.8%) 5,032 (61.6%)5 1,827 (21.6%) 1,887 (26.1%) < 0.0001
    Yes 4705 (75.2%) 3141 (38.4%) 6647 (78.4%) 5344 (73.9%)
Stable exclusive IQOS™ at week 48 (n [%])
    No 2978 (47.6%) 3358 (41.1%) 3406 (40.2%) 2605 (36.0%) < 0.0001
    Yes 3279 (52.4%) 4815 (58.9%) 5068 (59.8%) 4626 (64.0%)

Number of RF vs. RH indications and the likelihood of exclusive IQOS™ use in Japan.

Number of RF and/or RH indications RF indications (n = 4170) RH indications (n = 3894)
OR (95% CI) (n) OR (95% CI) (n)
0 Reference (1.0) 1391 Reference (1.0) 1471
1 1.15 (1.02–1.30) 1 693 1.34 (1.18–1.51) 667
2–5 1.41 (1.28–1.54) 1230 1.41 (1.27–1.55) 988
6–10 1.57 (1.37–1.79) 613 1.47 (1.28–1.68) 556
11–13 1.81 (1.46–2.24) 243 2.92 (2.29–3.72) 212

RF and/or RH indications, risk of stable non-exclusive IQOS™ use, percentage of stable exclusive IQOS™ users, and time to stable exclusive IQOS™ use.

Country Indicating vs. not indicating RF and/or RH as a reason for using IQOS™ during 48 weeks of follow-up
Risk 1 of becoming a stable non-exclusive IQOS™ user Percentage of stable exclusive IQOS™ users 2 until week 48 Mean number of weeks to stable exclusive IQOS™ use
Unadjusted analysis Adjusted analysis 3 Unadjusted analysis Unadjusted analysis
HR (95% CI) P HR (95% CI) P Indicating % (95% CI) Not indicating % (95% CI) P Indicating mean (95% CI) Not indicating mean (95% CI) P
Japan 0.74 < 0.0001 0.74 < 0.0001 61% 46% < 0.05 28.5 32.2 < 0.05
(N = 4557) (0.69–0.79) (0.69–0.80) (59%–63%) (43%–50%) (27.5–29.0) (31.1–33.4)
Italy 0.80 < 0.0001 0.80 < 0.0001 70% 55% < 0.05 20.1 26.9 < 0.05
(N = 6945) (0.76–0.84) (0.76–0.84) (68%–73%) (53%–56%) (18.9–21.2) (25.2–27.6)
Germany 0.82 < 0.0001 0.83 < 0.0001 69% 47% < 0.05 22.5 30.0 < 0.05
(N = 6437) (0.77–0.88) (0.76–0.90) (76%–70%) (44%–50%) (21.8–23.2) (28.8–31.2)
Russia 0.85 < 0.0001 0.84 < 0.0001 70% 62% < 0.05 22.7 25.3 < 0.05
(N = 5866) (0.81–0.91) (0.78–0.90) (68%–71%) (59%–64%) (22.0–23.5) (24.2–26.4)

RF and RH statements that could be indicated by participants as reasons for using IQOS™ by country 1.

Japan Two reasons referred to RF (the top 2) and two reasons to RH (the bottom 2)
• The tobacco vapor of IQOS has significantly less harmful chemicals than the smoke of conventional cigarettes, but using IOQS is not risk free.
• Has a significantly lower level of harmful chemicals in its vapor than conventional cigarettes.
• Because switching completely to IQOS is likely to present less risk of harm than continuing to smoke cigarettes (this does not mean IQOS is risk-free).
• Because switching completely to IQOS is a better choice than continuing to smoke 1-mg cigarettes (this does not mean IQOS is risk-free).
Italy and Russia One reason referred to RF
• The levels of harmful chemicals in IQOS vapor are significantly reduced compared to a standard cigarette smoke.
Germany One reason referred to RF
• IQOS contains 90% less harmful chemicals: IQOS reduces the concentration of a representative set of chemicals which are identified as being harmful in tobacco smoke on average by 90% in comparison to a cigarette.
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