New and Emerging Products That Can Get kids Hooked on Nicotine

Oral nicotine products – such as lozenges, nicotine pouches and gum – are becoming popular among young people. Several brands of these products come in a variety of appealing flavors and often contain high doses of nicotine, the addictive ingredient in all tobacco/nicotine products.

Despite not meeting the criteria to be classified as smoking cessation products (or quitting aids) by the U.S. Food and Drug Administration (FDA), some of these products are marketed this way anyway. Oral nicotine products differ from approved cessation therapies because they typically contain more nicotine and come in appealing flavors.

A survey conducted in the fall of 2021 found that 21% of underage youth reported using oral nicotine products in their lifetime; 12% used gums, 11% used pouches, 9% used lozenges, 8% used tablets, and 7% used toothpicks.^[1]

Some of the brands that sell oral nicotine pouches and lozenges are ZYN, Lucy, Rouge, on! and VELO. The most popular flavors are fruit, sweet/dessert/candy, alcohol, coffee, and mint/menthol, spice, and tobacco and they are marketed in bright, eye-catching colors.^[2] Some companies market their products as flavored “to mask the harshness of nicotine.” The use of appealing, candy-like packaging and an emphasis on flavors are a strong draw for children and teens. They also convey safety since they do not resemble cigarettes or other types of tobacco products that most kids now think of as unhealthy and risky. And because they resemble candy and gum or pouches hidden in the mouth, and produce no puff of smoke, vapor or distinct smell, they are highly discreet and easy to hide from adults.

IQOS Tobacco Heating Systems (THS) are devices that heat up tobacco without burning it, subsequently releasing tobacco aerosol that the user then inhales (and, to a lesser extent, by those near the user). IQOS stands for “I Quit Ordinary Smoking.”

Heated tobacco products are different from popular vaping products because they heat actual tobacco leaf as opposed to liquids containing nicotine. Philip Morris International, which created the IQOS THS, claims that this is a healthier alternative to smoking cigarettes, as it reduces the amount of smoke and harmful chemicals inhaled. HEETS, designed specifically for IQOS devices, are heated sticks intended to flavor THS devices. They come in a wide variety of flavors, similar to vaping cartridges.

The IQOS THS was authorized by the FDA to be marketed as modified risk tobacco products in 2020, implying that it might benefit the population’s health by encouraging smokers to transition away from combustible cigarettes. However, they are still not FDA-approved and not considered by the FDA to be safe.

A 2018 study found that the manufacturers of IQOS devices were unable to provide suitable evidence that young people would not be attracted to their products. The study also found that these devices’ distribution could lead adolescents and young adults to start using nicotine products.^[3]

Synthetic nicotine products are created with nicotine that is developed in a lab rather than extracted from the tobacco plant. Certain new products on the market, such as some disposable e-cigarettes and oral nicotine products, are made with synthetic nicotine. As with other nicotine products, these come in a variety of flavors and are marketed as safer to use than tobacco products. While the U.S. Food and Drug Administration (FDA) regulates all tobacco products, the regulations relating to synthetic nicotine products that do not derive from tobacco are new and not well enforced.

Puff Bar, for example, sells disposable e-cigarettes, which they claim to be entirely tobacco free and provide “satisfaction…without the residual impurities of tobacco.” These come in a few different designs and offer a large variety of flavors and corresponding colors, including “cool mint,” strawberry banana, mixed berries, and “blue razz.” As “disposable” products, they yield a certain number of “puffs” without being refilled or recharged. In March 2021, a group of organizations including the American Academy of Pediatrics and the Truth Initiative wrote to the FDA to urge them to remove Puff Bar products from the market and clarify the regulatory status of synthetic nicotine products.^[4]

A few brands that sell synthetic oral nicotine pouches include Bidi Pouches, NIIN, and Rush. Similar to oral nicotine products that are not synthetic, these pouches come in different flavors and colors, including “citrus chill” and cinnamon. NIIN claims that its products are made with “Certified Tobacco Free Nicotine” and are “completely free of the residuals and contaminants” of tobacco.

Regardless of its source – whether it comes from a plant or is made in a lab – nicotine is harmful to one’s health and especially harmful to young people. The current lack of regulation surrounding these products is highly concerning and must be addressed if we are to avoid another health epidemic like the one we just had when nicotine vaping products were allowed to saturate the market with limited-to-no government oversight.

While the exact effects of the new oral nicotine products have not yet been fully explored, their main ingredients and mechanisms of use are similar to vaping products. There is now established research showing their harms, especially among youth.

Use of any nicotine product can lead to nicotine addiction and increases the likelihood of cigarette and other tobacco product use. Inhaling the aerosols produced by these products leads to the ingestion of a broad range of toxic and cancer-causing substances. This has been linked to a variety of serious illnesses and health problems, including those that affect the lungs and the heart.