Assessment of changes in tobacco use behavior, tobacco product perception and product switching as a function of COVID-19 pandemic

ABSTRACT

Tobacco use in individuals is influenced by numerous factors. In an ongoing COVID-19 pandemic, there is more focus on maintaining good respiratory health. In such a scenario, introduction of novel tobacco products such as IQOS with claims of reduced exposure may influence perceptions and uptake. IQOS is a prototype of Heated tobacco products (HTPs) which is recently approved to be sold in US markets. This study evaluates if tobacco product sales differed after emergence of the pandemic and if risk perceptions for COVID-19 and IQOS reduced exposure claims influenced harm perceptions and likelihood to try IQOS. Additionally, COVID-19 risk perceptions and association with switching to less harmful alternatives in current cigarette smokers was assessed. In study 1, Nielsen sales data was analyzed from 2017-2021 for cigarettes, cigars, smokeless tobacco, and e-cigarettes in New York State (NYS) and remainder of North-east states. STATA was used to generate interrupted time series models for evaluating difference in sales before and after emergence of pandemic. Results indicated that cigarette sales did not significantly change in NYS or north-east states. Cigar sales significantly decreased in NYS whereas no significant change observed in north-east states. Smokeless tobacco did not show any significant changes in sales in NYS or north-east. E-cigarette sales reduced significantly in NYS but did not show significant differences in north-east states. The products which showed significant changes might also have been influenced by simultaneous policy changes such as increased cigar taxes and e-cigarette flavor ban in NYS in year 2020. In study 2, we recruited 600 users and non-users of tobacco for an online survey. Participants were randomly assigned to see one of the six IQOS ads. They were then asked about their risk perceptions for COVID-19, perceptions of IQOS and intentions to use and purchase IQOS. No significant differences in product appeal or intentions to try and purchase IQOS were observed between different ad groups. Higher product appeal for IQOS was associated with greater intentions to try and purchase IQOS. Those who were less worried about contracting COVID-19, also expressed a higher likelihood of purchasing IQOS.Study 3 recruited 200 current smokers for an online survey. Participants reported their cigarette use per day. They were assigned to read and/or listen to one of the four randomly assigned narrative conditions, where test narratives had COVID-19 and IQOS advocacy component. Participants further performed hypothetical purchases in an online Experimental Tobacco Marketplace (ETM) where cigarette prices increased in 5 ETM sessions. Results showed that cigarette demand reduced significantly as cigarette prices increased in ETM. There were no significant differences between purchases made by different narrative condition groups. No significant substitution of cigarettes with IQOS was observed in ETM sessions.To summarize, COVID-19 does not seem to have influenced tobacco use behaviors significantly. Effect of pandemic on tobacco sales is difficult to separate from simultaneously occurring policy changes and evolving risk perceptions. IQOS may have a greater appeal with reduced exposure claims and may influence interest in its uptake in never or former users of tobacco increasing its abuse liability. However, a limited potential of IQOS to replace cigarette use in current smokers indicates its low appeal and ability to be used in harm reduction. These findings may have implication for regulation of IQOS products and permission to be marketed in US with reduced exposure claims in future. (PsycInfo Database Record (c) 2023 APA, all rights reserved)