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Tobacco-free oral nicotine products were the second-most commonly used nicotine or tobacco items among more than 3,500 Southern California ninth- and tenth-graders surveyed last fall, researchers reported Aug. 8 in the journal Pediatrics.
About 3.4% of respondents said they'd tried the flavored nicotine products. E-cigarettes were the most popular, with 9.6% reporting that they'd vaped.
All other products, including tobacco cigarettes, had been used by fewer than 1% of teens polled.
This is the first study to try to assess how common these new nicotine products have become among teenagers, said lead researcher Alyssa Harlow, a postdoctoral scholar at the University of Southern California Keck School of Medicine.
These products are targeted directly to teens, offering them an alternative to vaping, Harlow said.
“The findings are concerning because these products have a high nicotine content, which we know is harmful for youth development,” she said. “They also come in a number of flavors and they do resemble candy, and in some cases, are indistinguishable from candy. The brands are also engaging in widespread digital media campaigns.”
The products resemble gum, candy or gummies, and are sold in flavors like “cherry bomb,” “blue raz,” “fruit medley” and “pomegranate,” researchers noted. Their flashy packaging distinguishes them from traditional nicotine replacement therapy products, researchers noted.
These new synthetic nicotine products mostly “came on the market as federal, state, and local governments began cracking down more strongly on e-cigarettes and popular vaping products like Juul,” said Linda Richter, vice president of prevention research and analysis at the Partnership to End Addiction.
“The idea was to skirt existing and emerging regulations aimed at restricting tobacco-based products – especially those that come in flavors and appeal to youth – by using synthetic nicotine rather than tobacco-derived nicotine,” she continued. “They are copying the successful tactics of the vaping industry by selling their products in youth-friendly flavors, packaging them in colorful and appealing ways, and selling them in forms that are discreet and seem less harmful to youth than smoked nicotine products.”
Exposure to nicotine can interfere with healthy brain development among teens, worsen mood disorders and mental health problems, and affect their ability to learn and pay attention, Harlow and Richter said.
It also puts them at increased risk of addiction to other substances, as well as other products containing nicotine, they said.
About 44% of teens who had smoked and vaped had tried these products, as had 27% of smokers and 22% of vapers, results show. Overall, smokers were 77 times more likely to have tried them and vapers were 40 times more likely than teens who had never used tobacco products.
“This might suggest that these young people have or are developing an addiction to nicotine and either replacing or supplanting their inhaled nicotine use with these oral products,” Richter said.
Some might use them because they are appealing, flavorful and seen as having a relatively low risk of harm compared to smoking or vaping, she added.
“However, these products are relatively new to the market and their use is not tracked in large, national surveys," Richter said. "As such, the research has yet to catch up to the emerging trend, and more research like that presented in this study is needed to understand the motivations for using oral nicotine among youth.”
The U.S. Food and Drug Administration in April received the authority from Congress to regulate tobacco products containing nicotine from any source, closing the synthetic nicotine loophole, FDA Center for Tobacco Products Director Brian King said in a statement published Aug. 3 on the agency's web site.
Nearly 1 million product applications from more than 200 separate companies had been submitted by May 14, King said.
Richter noted that the FDA has chosen to not impose an outright ban on the products.
“Instead, the FDA is requiring manufacturers and those who sell the products to comply with regulations to not sell to people under 21, not give away samples, and not make health claims or suggestions that the products are less harmful than cigarettes or other nicotine products,” Richter said.
The FDA has been sending warning letters to companies, ordering them to discontinue sales of any products that haven't received the agency's authorization.
The agency issued 102 warning letters on July 28 and 17 more on Aug. 1, King noted.
Richter noted that this is a rather slow pace of response, given that nearly 1 million products are seeking approval.
“[This] leave(s) most of these products in regulatory limbo, and they continue to be readily available to young people,” she said. Instead of allowing the products to remain on the shelves during its pre-market review process, the FDA should order removal of all unapproved nicotine products, she said.
“Every day, as the FDA struggles to catch up with the tremendous pile of applications from manufacturers seeking approval, new products are being introduced to the market and sold to young people who are most at risk of becoming hooked on the nicotine they contain,” Richter said.
The U.S. Food and Drug Administration has more on non-tobacco nicotine products.
SOURCES: Alyssa Harlow, PhD, postdoctoral scholar, University of Southern California, Keck School of Medicine, Los Angeles; Linda Richter, PhD, vice president, prevention research and analysis, Partnership to End Addiction, New York City; Pediatrics, Aug. 8, 2022
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