24 February 2021
 

Qualitative Health and Functioning Concept Elicitation Interviews in Japanese Users of Heated Tobacco Products 

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My name is Esther Afolulu. I'm a Senior Behavioral Scientist at PMI and I'll be presenting findings from a Qualitative Health and Functioning Concept Elicitation Interview Study in Japanese Users of Heated Tobacco Products.

This present study is a necessary step towards the development of a new, fit-for-purpose self-reported measure to enable the assessment of the self-reported impacts on the health and functioning of individuals who switch from cigarette smoking to using smoke-free tobacco and nicotine products such as heated tobacco products. 

 
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The objectives of the research were two-fold. First, to identify relevant concepts related to health and functioning that are important to Japanese smokers upon switching to the tobacco heating system (THS), commercialized as IQOS, and other similar heated tobacco products. And second, to develop a conceptual model of the identified concepts to help guide the development of the new self-reported health and functioning measure. To this end, we conducted one-hour face to face interviews with healthy adults of legal age for using tobacco products in Japan in two cities. So there were 19 interviews in Tokyo and 16 in Osaka. Participants were compensated around 15,000 yen, so approximately 140 U.S. dollars for their participation in the interview. 

There were enrolled based on tobacco use patterns and this included 15 smokers who switched exclusively to THS, 15 smokers who switched to THS and still use cigarettes, and 5 smokers who switched exclusively to another heated tobacco product, Ploom or Glo. The interviews were semi structured and used an interview guide designed to probe on any changes, small, large, negative or positive upon switching to heated tobacco products and the importance of any changes or no change. We used turning point retrospective techniques to discuss the transition when participants made this switch and we also had participants make visual collages to elicit concepts related to their health and functioning before and after the switch. Collages are predictive techniques that may encourage deeper self reflection and the discovery of concepts that may otherwise have been left unmentioned. They were an integral part of the methodology of the study and they worked well in this cultural context to enrich participants’ description of how their product use affected their health and functioning. 

So here's an example of such a collage for an exclusive THS user. When smoking cigarettes, they used a lot of dull and great images of smoke and ash, they have to brush their teeth a lot, they were bothered by the smell and they felt unfit. After the switch, they used more colorful images, they had whiter teeth, they felt fitter, there was less smell and they felt better. Qualitative analysis of the translated English interview transcripts and collages were conducted using ATLAS.ti software. 

For the results, the mean age of the participants was about 40 years old, with the majority being male. The main drivers on the line to switch to an easy tobacco product was typically internalized or externalized social pressure concerning the safety and social impacts of cigarette smoking. Few participants mentioned physical and mental health as motivating their switch to heated tobacco products. The breadth of the methodology allowed us to capture a wide range of concepts and domains of interest, which participants described in several changes and improvements related to their health and functioning upon switching. 

So concepts within respiratory symptoms such as cough and shortness of breath were listed by almost all participants. Concepts of oral health and appearance were also important to consumers. Concepts related to smell and senses and other physical health symptoms such as tiredness, sleep, headaches, throat symptoms were also listed. For functioning we had concepts related to physical functioning and day to day fitness, impact on daily activities, cognitive function and concentration and emotional effects such as mood and stress management. Effects on social functioning were widespread. Participants reported impact not only when interacting with people they knew and saw on a daily basis, such as their partners, children, friends and colleagues, but also when interacting with strangers or when being outside in a public space. 

So overall, there were perceived impacts of switching from cigarettes to heated tobacco product on health and functioning, including improvement and physical, social, and mental status. Improvements were perceived by both exclusive and dual THS users in all domains, however, these are more pronounced for exclusive THS users, who were more likely than dual users to view THS positively and to report improvements, especially in terms of physical health and functioning.  

There were also a lot of retrospective changes that participants only noticed after the switch, and these may be more difficult to assess in a self report measure over time, if participants do not realize or notice they experienced the concept, or that it was important until after the changes occurred. 

In conclusion, these rich consumer insights support the relevance of these outcomes and therefore the development of a new self-reported outcome measure to assess the impacts that different tobacco and nicotine products have on perceived health and functioning. 

Thank you for listening. Hope you enjoyed the presentation.

Important: This presentation is for the purpose of publishing and disseminating scientific information about Philip Morris International’s efforts to develop and assess product that have the potential to reduce individual risk and population harm associated with tobacco use. This presentation is for audiences of scientists, public health and regulatory communities, and other stakeholders with an interest in tobacco policy. The purpose is not advertising or marketing It is not intended for use by consumers.  

Nothing in this presentation should be construed as making any representation, express or implied, that the FDA has approved or has otherwise endorsed IQOS.

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