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The aim of this study was to assess the association between cigarette smoking and healthrelated quality of life (HRQoL) among students in two different universities, and the potential mediating effect of depression. Participants were students who came for mandatory checkups at Student Health Care Centers in two Universities in Serbia, differing by socio-politically and economically environments. Students completed socio-demographic questionnaire, Beck Depression Inventory (BDI) and the SF-36 questionnaire for assessment of HRQoL. In both populations, after adjustment for socio-demographic, behavioral and health factors, smoking was associated with poorer Mental Composite Score (MCS) and Physical Composite Score (PCS)

BackgroundPhilip Morris International’s IQOS (“I Quit Ordinary Smoking”) device has increasingly penetrated the global tobacco market. In Israel, among the first countries with IQOS in its market, the IQOS device is sold in specialty stores and online; the heat sticks – HEETS – are sold at traditional retailers. Advertising restrictions in many contexts including Israel have shifted industry marketing efforts to point-of-sale (POS). Given the nuances of IQOS and HEETS product distribution and the importance of POS marketing, we conducted a pilot study of IQOS POS marketing strategies.MethodsData collectors assessed product offerings, pricing, promotional strategies, and placement in a sample of 15 IQOS retailers (10 convenience stores, 3 grocery stores, 2 tobacco shops) in three Israeli cities (Beer-Sheva, Haifa, Jerusalem).ResultsAll retailers sold cigarettes; many carried other forms of tobacco (e.g., cigar products). Average price for a HEETS package was 30.2 Shekels (SD = 2.7); average price for the least expensive cigarette pack was 27.4 (SD = 1.5). HEETS were on average 9.5% more expensive than cigarettes. Posted ads were uncommon; rather, product displays were prominent. HEETS packages were often placed in a separate display box, at higher and more noticeable positions, and closer to consumers. Additionally, 11 retailers placed cigarettes and 10 placed HEETS near youth-oriented merchandise; 9 retailers placed cigarettes and HEETS, respectively, within 1 m of the floor.ConclusionsThis study represents an initial step in assessing IQOS POS practices – critical in advancing the ability to facilitate related research and regulation of emerging tobacco products in Israel and more broadly.

IQOS, the leading heated tobacco product globally, recently received ‘reduced exposure’ authorization from the US Food and Drug Administration. Independent research focusing on IQOS marketing and potential impact on consumers’ perceptions and behavior, and ultimately public health, is critical. The literature to date has underscored several concerns. First, Philip Morris’s (PM’s) marketing distribution requires scrutiny, particularly given its innovative promotional strategies. For example, IQOS is distributed via unique points-of-sale (POS; e.g., specialty and pop-up stores, “corners” in convenience stores) and uses various other opportunities (e.g., social media, sponsored events, direct-to-consumer). Second, although PM claims that IQOS’ target market is current combustible tobacco users and not young people, the literature indicates that in some populations, IQOS use is equally prominent among smokers and nonsmokers, and that specific subgroups (e.g., young adults, women) are targeted. Third, the impact of IQOS’ use of ad content promoting IQOS health benefits must be studied (e.g., how consumers interpret modified exposure messages). In conclusion, surveillance of IQOS marketing, particularly following reduced exposure authorization, is critical for obtaining valuable data to estimate population impact, particularly among population subgroups (e.g., young adults), and inform future tobacco regulation. These considerations have implications beyond IQOS—to other products and companies.