Risk perception of IQOS™ and cigarettes: Temporal and cross-country comparisons

BACKGROUND: Risk perception (RP) is central to smokers’ decision to switch to smoke-free tobacco and nicotine products (TNP). This study assessed temporal trends in the health RP of a novel heated tobacco product, IQOS(TM), relative to cigarettes, among current IQOS(TM) users. METHODS: The analyses included repeated cross-sectional data from online surveys in Germany (2018–19), Italy (2018–19), and Japan (2016–17, 2017–18, and 2018–19) among a random sample of current adult IQOS(TM) users from local registers of IQOS(TM) users. The health RPs of cigarettes and IQOS(TM) were assessed using the ABOUT™–Perceived Risk instrument, and their difference was described as the relative RP of IQOS(TM) to cigarettes (RP(Cig:)IQOS(TM)). RESULTS: After adjustment for covariates, the relative RP(Cig:)IQOS(TM) was higher in 2018 than in 2019 (0.93; standard error, 0.33; P = 0.005). This was driven by an increase in the RP of IQOS(TM) over time in Italy (2018: 42.6 [95% CI, 41.6–43.5]; 2019: 44.4 [43.4–45.4]) and Japan (2017: 44.0 [43.1–44.9); 2018: 45.9 [45.2–46.7]; 2019: 48.6 [47.9–49.4]), while the RP of cigarettes remained stable. CONCLUSIONS: The relative RP of IQOS(TM) decreased over time, driven by an increase in the RP of IQOS(TM), in agreement with epidemiological studies indicating a temporal reduction in the relative RP of smoke-free TNPs. Continued surveillance of the RP of novel TNPs is warranted to inform effective TNP risk communication and ensure that adults smokers who would otherwise continue to smoke understand the relative risks of novel TNPs.