and some biomarkers of harm may be reduced when switching from smoking combustible cigarettes to IQOS.1320 However, the public health impact of IQOS will depend on the degree to which use is less harmful than smoking, whether smokers switch completely to IQOS, and the extent of non-smoker uptake.17 21 Most research on consumer responses to IQOS has been conducted by PMI.2225 Independent survey research found that IQOS is perceived as less harmful than smoking.2628 Focus group studies in Switzerland and Japan found IQOS was more socially acceptable, cleaner and uptake was encouraged by clean and chic marketing and less of a harsh feeling on the throat compared with cigarettes.29 However, the bulkiness of the device, charging/cleaning, cost and the odd smell discouraged use.29 Popular reasons for using IQOS identified in a Swiss study included complete smoking cessation, the reduced toxicity relative to smoking, the reduced smell and the improved taste.28 Most users found IQOS weaker on the throat than combustible cigarettes and reported improved physical health, but feared becoming dependent.28 Due to increased availability of IQOS, its use for harm reduction and its rapid uptake in some countries,30 it is crucial that we develop a better understanding of smokers perceptions and responses to IQOS

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