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Comparative Study
. 2025 Jul 31;34(4):548-551.
doi: 10.1136/tc-2023-058509.

Low compliance and proliferation of IQOS purchase cues at points-of-sale: a comparative study before and after Israel's display ban

Yael Bar-Zeev  1 , Carla J Berg  2   3 , Amal Khayat  4 , Lorien C Abroms  2   3 , Yan Wang  2   3 , Zongshuan Duan  5 , Cassidy R LoParco  2 , Yuxian Cui  2 , Daniel Elbaz  4 , Hagai Levine  4
Affiliations
Comparative Study

Low compliance and proliferation of IQOS purchase cues at points-of-sale: a comparative study before and after Israel's display ban

Yael Bar-Zeev et al. Tob Control. .

Abstract

Introduction: It is unclear how tobacco companies respond to increasing restrictions on points-of-sale (POS) (eg, advertisement ban, display ban), especially regarding newer products, such as IQOS, a heated tobacco product. This study compared POS marketing strategies for IQOS (and HEETS tobacco sticks) before and after Israel implemented a display ban and plain packaging.

Methods: Audits of stores selling IQOS (n=87) in four Israeli cities were conducted, 16-20 months post display ban and plain packaging introduction, including previously audited stores (n=60) (prior to the implementation of these measures). Descriptive analyses and matched pre-post comparisons were conducted to assess regulatory compliance and marketing strategies over time.

Results: Almost all stores (90.8%) were non-compliant with the display ban; but most were compliant with plain packaging (81.6%) and advertisement ban (83.5%) regulations. Following the display ban, there was a significant increase in the number of IQOS/HEETS internal advertisements (21.7% vs 41.7%, p=0.023). These were mostly compliant with the advertisement ban (ie, did not mention the brand name explicitly), and appeared in the form of generic signs or flags and/or special displays. The percentage of stores featuring the IQOS device increased (1.7% to 20.0%, p=0.003), as did the percentage carrying at least four HEETS flavours (36.7% to 63.3%, p=0.006).

Conclusion: This sample of Israeli stores selling IQOS showed low compliance with the display ban. The increase in signs/special displays, mostly compliant with the advertisement ban, could serve as purchase cues circumventing the intent of the legislation. Regulatory efforts should consider more specific legislative language and comprehensive enforcement plans.

Keywords: Advertising and Promotion; Electronic nicotine delivery devices; Public policy; Surveillance and monitoring; Tobacco industry.

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Conflict of interest statement

Competing interests: YB-Z has received fees for lectures from Pfizer, Novartis NCH and GSK Consumer Health (distributors of smoking cessation pharmacotherapy in Israel) in the past (2012–July 2019). HL had received fees for lectures from Pfizer Israel (distributor of a smoking cessation pharmacotherapy in Israel) in 2017. LA receives royalties for the sale of Text2Quit.

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