IQOS point-of-sale marketing strategies in Israel: a pilot study

Israel was chosen as the site of this study because of its established IQOS market, with approximately 3250 IQOS retailers nationally [9]. Additionally, Israel is a democratic, multi-ethnic, high-income country [11] with a parliamentary, multiparty system and a modern market-based economy, suggesting that data derived here may be relevant to other countries likely to face IQOS market penetration. Regarding tobacco control, Israel signed and ratified the World Health Organization Framework Convention on Tobacco Control (FCTC) in 2003 and 2005, respectively. Currently, there are bans on billboard, radio, and TV advertising; advertising is allowed in certain sections of the press and on the internet [12]. At POS, there are no restrictions on advertising, but signage indicating minimum age for purchase (18 years) is required. In April 2017, after an appeal to the Israeli Supreme Court, IQOS was declared as a tobacco product, resulting in its being subject to the same marketing restrictions as other cigarettes. Given the restrictions on marketing in the regular media POS marketing is a critical marketing opportunity for IQOS. In January 2018, after an additional appeal, IQOS was taxed at the rate of other cigarettes [8].

In Spring 2018, two trained data collectors drew a sample of up to 7 retailers from three cities with high volumes of IQOS retailers (Beer-Sheva with 158 IQOS retailers; Haifa with 367 retailers; and Jerusalem with 310 retailers), using data from the PMI website [9] until the target sample size for this pilot (N = 15) was reached.

Based on the Standardized Tobacco Assessment for Retail Settings (STARS), which demonstrates high reliability [10], a similar assessment tool was developed to include HTPs, specifically IQOS, as IQOS is presently the only HTP in the Israeli market. The three authors developed the tool to include measures based on content relevance and reliability, adapted to include HTPs.

The final assessment tool assessed: 1) store characteristics (i.e., type of store, signage indicating minimum age requirements for purchasing tobacco); 2) products sold (i.e., cigarettes, little cigars or cigarillos [LCCs], large cigars, smokeless tobacco [e.g., chew, dip, snus], electronic nicotine delivery systems [ENDS] other than HTPs, HTPs which were exclusively IQOS; 3) price (i.e., least expensive price of a cigarette pack and HEETS) and any price promotions across products; 4) promotional strategies, including product advertisements outside or inside of the store, ability to sample products, and special promotions for populations (e.g., military, college students) or loyalty club memberships; and 5) placement, including IQOS displays, placement near to youth-oriented merchandise (specifically placement of products within 30 cm of toys, candy, gum, slushy/soda machines, or ice cream), and whether products were displayed within one meter of the floor (which aligns with the field of vision of youth).

The data collectors were trained to use the assessment tool by the lead author (YBZ). Free text notes were filled in with comments and information provided by the merchants. In particular, data collectors noted merchant comments regarding IQOS product safety/harm, potential cessation or harm reduction benefits, and benefits related to secondhand smoke/smell.

Given the study’s exploratory nature and small sample size, we used SPSS 23.0 to conduct descriptive statistics only.

Table 1 present data from the POS assessments across the 15 IQOS retailers. The Beer-Sheva sample consisted of 5 convenience stores. The Haifa sample consisted of 3 convenience stores, 3 grocery stores, and 1 tobacco shop. The Jerusalem sample consisted of 2 convenience stores and a tobacco shop.

Ten (66.7%) of retailers posted signage indicating the minimum age to purchase tobacco products; 6 (40.0%) of retailers posted minimum age signage specific to purchasing HTPs.

All retailers sold cigarettes, 10 LCCs, 9 large cigars, 10 smokeless tobacco, 2 ENDS, and 11 nargila/waterpipe/hookah.

The average price for the least expensive HEETS purchase was 30.2 Shekels (SD = 2.7); whereas, the average price for the least expensive cigarette pack was 27.4 (SD = 1.5). We also examined the price of HEETS relative to the least expensive price for a PMI cigarette pack (most commonly “Next”). In all but one retailer, HEETS were sold at a higher price, on average 9.5% more expensively, with the price difference ranging from 1 to 11 Shekels. Price promotions were rare in general (2 retailers offered them for cigarettes; none offered for other products).

Exterior advertisements were uncommon, with only 3 having cigarette ads, 1 for smokeless tobacco, 1 for ENDS, and 2 for nargila/waterpipe/hookah. Interior ads were also uncommon; rather, product displays were prominent. No retailer had specific ads for HEETS. Free samples were not provided, and no retailers offered any special promotions for populations (e.g., military, college students) or loyalty club memberships.

Eleven retailers placed cigarettes and 10 placed HTPs near youth-oriented merchandise. Also, 9 retailers placed cigarettes and HTPs, respectively, within 1 m of the floor. Further, in 8 retailers, HEETS packages were separated from other tobacco products sold, and placed in a separate display box. In 2 retailers, HEETS displays were placed at higher and more prominent positions, closer to consumers, and with color coding to differentiate the tobacco flavoring and strength.

When asked directly, retailers stated HTPs were less harmful (26.7%), can be used as a method for quitting or reducing number of conventional cigarettes smoked (13.3%), and do not emit smoke and produce less adverse smell (40.0%).