Cigarette smoking hit a historic low in 2023, with the adult smoking rate falling to 11%, according to the CDC. In response to the steady decline of smokers over the years, tobacco companies have served up an assortment of products to retain customers and attract new users, including flavored e-cigarettes and “little cigars.”
A recent addition is the oral nicotine pouch—a small permeable pouch typically placed between the lip and gum—that contains crystalized nicotine powder and comes in a variety of flavors, including citrus, mint, and mango. A top-selling brand is ZYN, which has spawned “Zynfluencers” on social media. One of the fastest-growing nicotine product categories, pouch sales increased from 126.06 million units in 2019 to 808.14 million units in 2022, yet little is known about the products.
To help fill that knowledge gap, Meghan Moran, PhD, MA, associate professor in Health, Behavior and Society, and Tory Spindle, PhD, associate professor in Psychiatry and Behavioral Sciences at the School of Medicine, are conducting a five-year research project on oral nicotine pouches funded by the National Institute on Drug Abuse.
“We have an interest in understanding how these products are being designed and marketed and what are the behavioral effects,” says Moran.
Here, Moran discusses public health implications of oral nicotine pouches, product marketing, and potential regulatory issues.
What marketing messages do these products telegraph to consumers?
We see the wording “tobacco-free,” and “smoke-free” being used a lot, as well as “synthetic nicotine,” which could serve to differentiate this product from other tobacco products in consumers’ mental space as something that is safe to use. Something that could be attractive to youth are the flavors in these products, which we've seen with e-cigarettes: Attractive-sounding flavors can induce curiosity, which is one of the first steps toward initiating use.
We also see a lot of marketing that the pouches are discreet, that they are spit-free and odor-free. My hypothesis is that smokers will find this attractive because it allows them to get nicotine in settings where smoking is not allowed—on an airplane or at work or just enjoying time inside with their families. The pouches are fairly small, so chances are you can easily hide the fact that there's a pouch in your mouth. The industry will claim, “Well, this is something that adult smokers want, and we are allowed to market to them.” But it just so happens that younger people may find it attractive as well.
What are your concerns about the risk of addiction?
Nicotine is a drug that is exceptionally difficult to quit and can have negative health effects. We're particularly concerned about these products becoming a pathway to nicotine addiction for young people. They may not be as dangerous as cigarettes, but they certainly are not harm-free, so we don't want anybody who doesn't use them to start.
And young folks generally do not know what nicotine addiction is like; they have no way of knowing how easy it is to become addicted or how difficult it will be for them to quit. Adolescents in particular can be overly confident in their own abilities: “Well, some people might not be able to quit, but I will.”
How do these products compare to e-cigarettes in terms of safety?
We don't know the answer to that yet. I think most people in the field would agree that if somebody who smokes combustible cigarettes, particularly a heavier smoker, were to change their behavior to exclusively use these products, that would be a benefit for their health. It would not be as good as quitting completely. But there are some people who either don't want to quit nicotine completely, or can't, so this might be an option.
Like many others, I think of these products as potential harm reduction options, but looking at the bigger picture, we need to work on expanding ways to help people quit nicotine completely.
What do you hope to learn from the NIDA research project?
Tory Spindle is working with people who smoke and studying how products with different levels of nicotine and different flavors interact and affect the movement of nicotine through the body. What we've learned from the lab work so far is that for smokers who haven't had nicotine for a set period of time and are craving nicotine, the pouches do seem to dampen those cravings, which is something you want in a product that's going to help somebody quit smoking. But it’s yet to be seen whether it’s going to be useful in the long term.
Simultaneously, I'm leading a study on how the products are being marketed. We’re collecting hundreds of advertisements since 2021 and documenting the words they’re using and the claims being made to sell the products. Is there any content that could potentially be in violation of the Tobacco Control Act? We're now integrating what we're learning from that into a study where we'll show the advertisements to young people who are mostly inexperienced or naive to tobacco products and to adults who smoke to understand what specifically is appealing in the marketing.
The next phase culminates in a behavioral study that will close the loop in seeing the entire pathway that a person will go through in the real world, from the point that they first learn about a product through the marketing to the point at which they make that decision to use it.
The hope is that it [the research] will be useful to those who regulate the marketing of these products. If we discover the companies are doing things that are uniquely appealing to youth, we want that to stop. If, as the science advances, we feel more confident that these could be potential harm reduction tools, then we might learn something that could help us increase the motivation of smokers to switch to these products.
Jackie Powder is the associate editor of Hopkins Bloomberg Public Health magazine.
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