E-cigarettes have disproportionately attracted youths and are the most commonly used tobacco product among young people in the US.^1-7 According to the most recent available data, 18% of young adults in 2021⁸ and 10% of middle and high school students in 2023⁷ reported current e-cigarette use. Young people are not merely experimenting with e-cigarettes but are increasingly becoming established users, with nearly half (46%) of young adults and a quarter (25%) of adolescents who use e-cigarettes reporting daily use.^7,8 It has been hypothesized that nicotine dependence in young people has increased because of the market transitioning from harsher freebase nicotine to more palatable nicotine salts.^9-11 While e-cigarettes may serve as a safer alternative to regular cigarettes for adults who smoke^12-14 and may have reduced smoking among youths,¹⁵ studies on the effect of e-cigarette characteristics, including nicotine form, on abuse liability are urgently needed to address the high rates of e-cigarette use among young people.

Background Oral nicotine pouches (ONPs) have rapidly gained popularity in recent years. While ONPs likely expose users to fewer toxicants than cigarettes, they contain nicotine and may initiate, sustain or increase nicotine addiction and dependence. Monitoring the ONP marketplace is essential to inform timely regulatory action. Methods We used Nielsen ScanTrack data to analyse ONP sales and prices from 2021 to 2024. Joinpoint regression assessed sales and price trends, and ordinary least squares regression evaluated the association between ONP sales and product characteristics. Results Monthly ONP unit sales increased significantly, from 327 million in July 2021 to 1046 million in May 2024—more than tripling over this period (p<0.001, average monthly per cent change (AMPC)=3.45). Inflation-adjusted prices also rose, from 19 cents/pouch in June 2021 to 22 cents/pouch in May 2024 (p<0.001, AMPC=0.50). The sales of ZYN, On!, Rogue and VELO account for 99.8% of total sales. ONPs with explicit flavour descriptors outsold those with implicit flavour descriptors by more than eight times. The ‘chill’ flavour had also gained notable popularity. ONPs with 6 mg and 3 mg nicotine concentrations made up 68% of total sales. Additionally, ONPs with explicit flavour descriptors and higher nicotine concentrations were associated with increased sales. Conclusions Policy-makers may need to consider the role of major manufacturers, product flavours, and nicotine content in shaping the market. Continued surveillance is warranted to assess trends in use, particularly among youth and non-tobacco users.

Background and aims: Oral nicotine pouches (ONPs) probably offer reduced harm compared with cigarettes, but independent data concerning their misuse liability are lacking. We compared nicotine delivery and craving relief from ONPs with different nicotine concentrations to cigarettes.Design: This was a single‐blind, three‐visit (≥ 48‐hour washout), randomized‐cross‐over study. Participants were encouraged to complete all study visits in less than 1 month.Setting: The study took place in Rural/Appalachian Ohio.Participants: Participants comprised 30 adults who smoke cigarettes. Participants (mean_age = 34.5) were 60% men and 90% White.Intervention: Participants who were ≥ 12‐hour tobacco‐abstinent used: (1) a 3‐mg nicotine concentration ONP, (2) a 6‐mg nicotine concentration ONP and (3) usual brand cigarette in separate visits. ONPs (wintergreen Zyn) were used for 30 minutes; cigarettes were puffed every 30 sec for 5 minutes.Measurements: Plasma nicotine and self‐reported craving were assessed at t = 0, 5, 15, 30, 60 and 90 minutes. The primary outcome was plasma nicotine concentration at t = 30 minutes. A secondary outcome was craving relief at t = 5 minutes.Findings: At t = 30, mean [95% confidence interval (CI)] plasma nicotine was 9.5 ng/ml (95% CI = 7.1, 11.9 ng/ml) for the 3 mg nicotine ONP, 17.5 ng/ml (95% CI = 13.7, 21.3) for the 6 mg nicotine ONP and 11.4 ng/ml (95% CI = 9.2, 13.6 ng/ml) for the cigarette. Mean plasma nicotine at t = 30 minutes differed between the 3‐ and 6‐mg nicotine ONPs (P = 0.001) and between the 6‐mg nicotine ONP and cigarette (P = 0.002). Mean (95% CI) craving at t = 5 minutes was lower for the cigarette (mean = 1.00, 95% CI = 0.61, 1.39) than either the 3 mg (mean = 2.25, 95% CI = 1.68, 2.82; P < 0.0001) or 6 mg nicotine (mean = 2.19, 95% CI = 1.60, 2.79; P < 0.0001) ONP.Conclusions: Among adult smokers, using 6‐mg nicotine concentration oral nicotine pouches (ONPs) was associated with greater plasma nicotine delivery at 30 minutes than 3‐mg ONPs or cigarettes, but neither ONP relieved craving symptoms at 5 minutes as strongly as a cigarette. Accelerating the speed of nicotine delivery in ONPs might increase their misuse liability relative to cigarettes.

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Background: Oral nicotine pouches (ONPs) are novel products that are marketed as “tobacco-free” alternatives to cigarettes and smokeless tobacco (ST). This study examined the effects of ONP packaging features on adult tobacco users’ and non-users’ product perceptions. Materials and Methods: Adult tobacco users (cigarettes, ST, and dual cigarette/ST) and non-users (total N = 301) viewed ONP pack images in a 4 × 3 × 2 between-subject experiment testing the effects of the displayed flavor (cool mint, coffee, dark frost, and smooth), nicotine concentration (none displayed on the package, 3 mg, and 6 mg), and addiction warning label (yes or no). The outcomes were perceived substitutability of ONPs for cigarettes and ST and perceived risks. We modeled the effects of tobacco user status and the experimental factors on these outcomes. Results: All tobacco user groups perceived ONPs to be significantly less harmful and less addictive than non-users. There were significant effects of nicotine concentration on perceived risks. Compared to packages that did not display nicotine concentration, packages displaying 6 mg nicotine concentration produced significantly lower perceived harm (β = −0.23, 95% CI −0.44, −0.02), perceived addictiveness (β = −0.28, 95% CI −0.51, −0.05), risk appraisals of harm (β = −0.50, 95% CI −0.88, −0.12) and risk appraisals of addictiveness (β = −0.53, 95% CI −0.95, −0.11). Conclusions: The study findings demonstrate that the nicotine concentration displayed on ONP packaging can affect adults’ perceptions of ONPs. Further research on the effects of ONP packaging features emphasizing nicotine (e.g., “tobacco free” nicotine claims) on tobacco users and non-users is needed to assess their potential public health impact.