Low compliance and proliferation of IQOS purchase cues at points-of-sale: a comparative study before and after Israel's display ban

Yael Bar-Zeev, Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem - Hadassah Medical Centre, Jerusalem, Israel yael.bar-zeev@mail.huji.ac.il.
Carla J. Berg, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Amal Khayat, Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem - Hadassah Medical Centre, Jerusalem, Israel.
Lorien C. Abroms, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Yan Wang, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Zongshuan Duan, Population Health Sciences, Georgia State University, Atlanta, Georgia, USA.
Cassidy R. LoParco, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Yuxian Cui, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Daniel Elbaz, Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem - Hadassah Medical Centre, Jerusalem, Israel.
Hagai Levine, Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem - Hadassah Medical Centre, Jerusalem, Israel.

Document Type

Journal Article

Publication Date

6-11-2024

Journal

Tobacco control

DOI

10.1136/tc-2023-058509

Keywords

Advertising and Promotion; Electronic nicotine delivery devices; Public policy; Surveillance and monitoring; Tobacco industry

Abstract

INTRODUCTION: It is unclear how tobacco companies respond to increasing restrictions on points-of-sale (POS) (eg, advertisement ban, display ban), especially regarding newer products, such as IQOS, a heated tobacco product. This study compared POS marketing strategies for IQOS (and HEETS tobacco sticks) before and after Israel implemented a display ban and plain packaging. METHODS: Audits of stores selling IQOS (n=87) in four Israeli cities were conducted, 16-20 months post display ban and plain packaging introduction, including previously audited stores (n=60) (prior to the implementation of these measures). Descriptive analyses and matched pre-post comparisons were conducted to assess regulatory compliance and marketing strategies over time. RESULTS: Almost all stores (90.8%) were non-compliant with the display ban; but most were compliant with plain packaging (81.6%) and advertisement ban (83.5%) regulations. Following the display ban, there was a significant increase in the number of IQOS/HEETS internal advertisements (21.7% vs 41.7%, p=0.023). These were mostly compliant with the advertisement ban (ie, did not mention the brand name explicitly), and appeared in the form of generic signs or flags and/or special displays. The percentage of stores featuring the IQOS device increased (1.7% to 20.0%, p=0.003), as did the percentage carrying at least four HEETS flavours (36.7% to 63.3%, p=0.006). CONCLUSION: This sample of Israeli stores selling IQOS showed low compliance with the display ban. The increase in signs/special displays, mostly compliant with the advertisement ban, could serve as purchase cues circumventing the intent of the legislation. Regulatory efforts should consider more specific legislative language and comprehensive enforcement plans.

Department

Prevention and Community Health

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