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Introduction IQOS entered the US market in October 2019, then received the Food and Drug Administration’s modified risk tobacco product authorization (MRTPA) allowing use of “reduced exposure” claims in marketing in July 2020. A May 2021 court decision regarding patent infringement required IQOS’ removal from the US market in November 2021. Methods Using 2019-2021 Numerator marketing data, this study characterized ad occurrences and expenditures – including allocation per ad content (headline theme, imagery) and media type and channel – pre- and post-MRTPA; exploratory analyses characterized the post-court to withdrawal period separately. Results The study period entailed 685 occurrences and $15,451,870 in expenditures. The proportions of occurrences across the 3 periods (pre-MRTPA, post-MRTPA, post-court) were 39.3%, 48.8%, and 12.0%, respectively (p<.001); the proportions of expenditures were 8.6%, 30.0%, and 61.5%. Overall, 73.1% of ad occurrences were via online display; 99.6% of expenditures occurred in print. Per occurrences, prominent pre-MRTPA headline themes included “future” (40.2%), “real tobacco” (38.7%), “get IQOS” (35.3%), and “innovation/technology” (20.1%); post-MRTPA, prominent themes included “not burned/heat control” (32.7%), “reduced exposure” (26.4%), and “distinct from e-cigarettes” (20.7%). Visuals/images mainly depicted the product alone (pre-MRTPA: 86.6%; post-MRTPA: 76.1%), but increasingly featured women (pre-MRTPA: 8.6%; post-MRTPA: 21.5%). The most prominent media channel theme pre-MRTPA was “technology” (19.7%), but post-MRTPA included “fashion/women” (20.4%) and “entertainment/pop culture/gaming” (19.0%). Conclusions IQOS leveraged MRTPA in ads, continued marketing post court decision, and targeted key consumer groups (i.e., women). Marketing surveillance of products granted MRTPA is needed, domestically and in other countries, to assess its use and impact. IMPLICATIONS Philip Morris (PM) leveraged IQOS’ modified risk tobacco product authorization (MRTPA) from the US Food and Drug Administration (FDA), and continued marketing IQOS after its withdrawal from the US market due to a patent infringement related court decision. Notably, IQOS marketing increasingly targeted key consumer groups (e.g., women). Given IQOS’ potential return to the US, PM’s use of FDA’s MRTPA to promote IQOS as a risk reduction product in other countries, and FDA’s MRTPA for other products, it is crucial to monitor products receiving MRTPA, their marketing, and their population impact, domestically and in other countries.

ObjectiveThis study explored the nature and extent of tobacco product availability at retailers near junior, senior and vocational high schools in rural and urban areas in 10 cities across China, including Shanghai, Beijing, Guangzhou, Chongqing, Shenyang, Jinan, Kunming, Guilin, Kaifeng and Baiyin.MethodsTobacco sales at 1612 retailers around 904 schools (within 100 m for urban schools and within 250 m for rural schools) were observed by trained data collectors with an online observation form in 2021. Multistage sampling with simple random sampling at each stage was used to select schools from the city district-level/rural county-level divisions. χ2 tests and analyses of variance were used to analyse the data.FindingsOver half of urban schools (57.0%) and a large majority of rural schools (71.0%) had a cigarette retailer within a 100 m and a 250 m radius, respectively. Nearly all cigarette and electronic cigarette (e-cigarette) retailers displayed tobacco products inside. Majority of cigarette retailers (63.2%) sold flavoured cigarettes, of which 88.6% sold menthol/mint-flavoured cigarettes. Approximately half of these retailers did not display required signage prohibiting sales to minors. Overall, outcomes varied across cities and between urban and rural areas, but not by school type.ConclusionDisplay of tobacco products is very prevalent near schools in 10 cities across China. In contrast, compliance with posting ‘no sales to minors’ signs is low. Our findings suggest that effective enforcement of prohibiting tobacco retailers around schools and stronger restrictions on tobacco displays and flavoured cigarettes and e-cigarettes are needed to protect youth in China.