Discussion of heated tobacco products on Twitter following the IQOS’s Modified-Risk Tobacco Product authorization and US import ban: An observational study (Preprint)

Abstract

Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions.

We analyzed heated tobacco product (HTP)-related posts on Twitter during the period that included important policy events around IQOS.

N=10,454 public English tweets (posted June 2020-December 2021) were collected using HTP-related keywords. We randomly sampled n=2,796 tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes.

Tweet volumes peaked around IQOS-related policy events, such as the US FDA’s modified risk tobacco product (MRTP) authorization (July 2020) or the US import ban (November 2021). Personal testimonials were most common (58% of analytic set), followed by news/information (31%), and marketing/retail (11%). Among the personal testimonials, more tweets were positive (46%) than negative (23%), often comparing the health risks of HTPs to cigarettes. About 10% of the direct marketing/retail tweets raised concerns about cross-border promotions. Neutral testimonials mentioning IQOS brand (44%) and neutral testimonials discussing policy (23%) showed the largest pairwise co-occurrence.

Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict online tobacco marketing, our results suggest that retailers may circumvent such regulations by operating overseas.