Classification, Perception, and Toxicity of Emerging Flavored Oral Nicotine Pouches

Chronic airway inflammatory diseases and e-cigarette use: a review of health risks and mechanisms

Chronic airway inflammatory diseases, which primarily include chronic obstructive pulmonary disease (COPD), asthma, allergic rhinitis, and chronic sinusitis, continue to have a high global prevalence, highlighting their significant public health impact. Concurrently, the use of e-cigarettes (tobacco e-cigarettes) has been rising worldwide, with many users perceiving them as a safer alternative to traditional cigarettes. However, accumulating evidence from international studies suggests that e-cigarettes pose substantial health risks. This review aims to explore recent research on the relationship between e-cigarette use and chronic airway inflammatory diseases. The findings indicate that e-cigarette usage increases the risk of developing these conditions. Specifically, studies have shown that e-cigarettes exacerbate airway inflammatory responses, elevate levels of type 2 inflammatory cytokines such as IL-4, IL-5, and IL-13, increase cellular oxidative stress, and impair lung function. These mechanisms may collectively contribute to an increased risk of chronic airway inflammatory diseases potentially associated with e-cigarette use.

A comprehensive review on oral nicotine pouches: Available scientific evidence and future research needs

Oral nicotine pouches (ONPs) are an emergent class of tobacco products that, unlike conventional oral smokeless tobacco products, contain a nicotine powder instead of tobacco leaves. This review synthesizes available data on ONPs in key research domains including survey studies, marketing/advertising studies, chemical characterization and in vitro studies, and clinical studies. Research findings relevant for ONP regulations are summarized, including who uses these products and why, how marketing tactics influence appeal and use intentions, what harmful and potentially harmful constituents they contain, and what acute effects they have on humans. Taken together, the current data suggest that ONPs likely produce less harm to individual users than conventional tobacco products (e.g., moist snuff, cigarettes) and can acutely suppress nicotine/tobacco withdrawal symptoms among current cigarette smokers. Thus, ONPs may be a viable harm reduction option for individuals who switch completely to using them from conventional products. However, randomized controlled trials are needed to determine if established tobacco users would use ONPs long term, and more independent academic research is needed given that most ONP studies to date are tobacco industry-funded. Additionally, ONPs have qualities (e.g., flavors, marketing claims of "tobacco free") that could increase appeal among youth and young adults, and these products can deliver nicotine at levels sufficient to cause dependence; widespread adoption of ONPs among otherwise nicotine-naive individuals may reduce their net public health benefit. This review concludes by suggesting future research directions necessary to increase scientific understanding of ONPs and inform regulations for these increasingly popular products. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Assessing Text Messaging Interactivity with a Vaping Cessation Intervention Among Latino Young Adults: A Quantitative and Qualitative Analysis

OBJECTIVE

To assess text messaging interactivity with a vaping cessation intervention among Latino young adults.

METHODS

As part of a single-arm pilot study, 40 Latino young adults (ages 18-25) received Kick Vaping, a vaping cessation text messaging intervention. Kick Vaping, available in English and Spanish, was developed in partnership with a Community Advisory Board of Latino young adults and consisted of 212 text messages delivered throughout a 3-month period. Participants' text messaging interactions with Kick Vaping were quantitatively and qualitatively analyzed.

RESULTS

Quantitative: During the 3-month period, participants sent a total of 713 text messages (mean = 17.8, SD = 27.6, range = 0-127). Text messaging interactivity varied among participants: Two participants (5%) did not interact with the program, 22 (55%) had a low interaction with the program (1-9 text messages), 12 (30%) had a medium interaction (10-49 text messages), 3 (7.5%) had a high interaction (50-99 text messages), and 1 (2.5%) had a very high interaction (≥100 text messages). Qualitative: Several themes were identified: (1) Reasons to quit, (2) strategies to quit, (3) benefits of quitting, (4) self-efficacy, (5) barriers to quitting, (6) extra-treatment social support, and (7) intra-treatment social support.

CONCLUSION

The Kick Vaping intervention generated different levels of text messaging interactivity among Latino young adults. Participants' text messaging interactivity provides important insights into their experiences using such intervention. These insights offer practical operational strategies to address vaping cessation among Latino young adults.

Randomized crossover clinical studies to assess abuse liability and nicotine pharmacokinetics of Velo Oral Nicotine pouches

Introduction

Oral nicotine pouches (ONPs) are a newer category of smokeless tobacco products containing pharmaceutical-grade nicotine but no tobacco leaf. These products have the potential to help smokers transition away from cigarettes. To assess their potential role as alternatives to cigarettes, we evaluated the abuse liability (AL) of Velo ONPs with varying nicotine content (4-12 mg per pouch), pouch size (600 mg or 400 mg) and flavor (six varieties) in comparison to high (cigarettes) and low (nicotine replacement therapy [NRT] gum) AL comparators.

Methods

Independent randomized crossover clinical studies were conducted to assess AL, including subjective effects (product liking [PL], urge to smoke, product effects, overall PL, and overall intent to use again) and nicotine pharmacokinetic (PK) parameters of Velo ONPs. Participants used test products under controlled conditions, and subjective effect measures were collected using validated questionnaires. Nicotine PK parameters, including peak nicotine concentration (Cmax), time to maximum concentration (Tmax), were assessed.

Results

Mean PL scores for all Velo ONPs (p < 0.0042) and Velo Mini Pouches (p < 0.0031) were significantly lower than cigarettes, regardless of nicotine level, pouch size, or flavor, but similar to NRT gum. Other subjective measures for Velo ONPs were less favorable than cigarettes and comparable to or lower than NRT gum. Nicotine uptake with Velo ONPs was slower (reflected by a longer Tmax) and had lower Cmax than cigarettes but was comparable or slightly lower than NRT gum. Overall nicotine uptake increased with increasing nicotine content and was comparable to that of cigarettes for Velo ONPs with higher nicotine levels. Flavor had no effect on nicotine uptake of Velo ONPs.

Discussion

Velo ONPs demonstrated an AL profile lower than cigarettes and similar to NRT gum, suggesting a reduced potential for abuse compared to cigarettes. The slower nicotine uptake and lower peak nicotine levels further support their potential as a lower-risk alternative. These findings highlight the potential role of ONPs in tobacco harm reduction strategies by providing an alternative nicotine source with a lower AL than combustible cigarettes.

Systematic Review Registration

The clinical studies were registered at ClinicalTrials.gov; NCT05129657, NCT05294497, and NCT05081154.

Examining the flavor descriptors of e-cigarettes, heated tobacco products, and nicotine pouches in the Philippines: Regulatory challenges and opportunities

In the Philippines, the regulation of e-cigarettes, heated tobacco products (HTPs), and nicotine pouches under Republic Act 11900 or the Vape Law is crucial as their use continues to rise. As e-cigarettes are rapidly gaining popularity due to their social appeal, perceived novelty, ever-changing flavors, and sensations that are attractive to consumers, HTPs and nicotine pouches are continuously developing as well. This study aims to characterize e-cigarette, HTP, and nicotine pouch flavor descriptors in the Philippines and to assess the regulatory implications of existing policies regulating these products. We adapted the Tobacco Pack Surveillance System (TPackSS) data collection protocol developed by the Institute for Global Tobacco Control and employed both inductive and deductive thematic analyses to categorize flavor descriptors from 278 e-cigarette, HTP, and nicotine pouch products. We identified 11 categories of flavor descriptors: colors (18.08%), fruits (15.07%), codes or acronym-like descriptors (13.70%), concept descriptors (12.05%), menthol (10.96%), beverages (9.86%), sweet (8.22%), miscellaneous (5.48%), pop culture (3.56%), tobacco (2.47%), and nuts (0.55%). We also examined the flavor imagery, marketing tactics, and promotional strategies on these products. To effectively regulate e-cigarettes, HTPs, and nicotine pouches, we recommend streamlining their governing policies. Establishing a complete flavor ban on appealing flavors, descriptors, and imagery is crucial to curbing use. Additionally, increasing taxation and implementing plain packaging can reduce the marketing appeal of these products, thereby enhancing prevention and control efforts.

Impact of Smokeless Oral Nicotine Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment: A Policy Statement From the American Heart Association

Smokeless oral nicotine products are addictive, and their use has potential adverse effects on some but not all biomarkers of cardiovascular risk. The use of some types of these products, for instance, is associated with an increased mortality risk in those with ischemic heart or cerebrovascular disease. Similarly, smokeless tobacco has the potential to increase the risk of oral cancer, but the risks depend on the chemical composition of the product. The market of smokeless oral nicotine products has transformed since the last American Heart Association smokeless tobacco policy statement. Several varieties of tobacco-free oral nicotine products-including oral nicotine pouches; nontherapeutic nicotine gums, lozenges, and tablets; and nicotine gummies-have rapidly proliferated. The sales of oral nicotine pouches, in particular, have increased substantially; however, no data are available on their cardiovascular or health risks. In addition, synthetic (compared with tobacco-derived) nicotine has been used in some brands of oral nicotine products, but its cardiovascular and health effects have been inadequately studied. Robust public policy levers are identified to support ending addiction to all commercial tobacco products. Critical components and policy initiatives include clinicians emphasizing the prevention of tobacco product initiation and supporting cessation with established pharmacological and behavioral tobacco dependence treatment therapies as primary goals for achieving an end to commercial tobacco and nicotine addiction.

Synthetic cooling agent in oral nicotine pouch products marketed as 'Flavour-Ban Approved'

BACKGROUND

US sales of oral nicotine pouches (ONPs) have rapidly increased, with cool/mint-flavoured ONPs the most popular flavour category. Restrictions on sales of flavoured tobacco products have either been implemented or proposed by several US states and localities. Zyn, the most popular ONP brand, is marketing Zyn Chill and Zyn Smooth as 'Flavour-Ban Approved' or 'unflavoured', probably to evade flavour bans and increase product appeal. At present, it is unclear whether these ONPs are indeed free of flavour additives that can impart pleasant sensations such as cooling.

METHODS

Sensory cooling and irritant activities of 'Flavour-Ban Approved' Zyn ONPs, Chill and Smooth, along with minty varieties (Cool Mint, Peppermint, Spearmint, Menthol), were analysed by Ca2+ microfluorimetry in HEK293 cells expressing the cold/menthol (TRPM8) or menthol/irritant receptor (TRPA1). Flavour chemical content of these ONPs was analysed by gas chromatography/mass spectrometry.

RESULTS

Zyn Chill ONP extracts robustly activated TRPM8, with much higher efficacy (39%-53%) than the mint-flavoured ONPs. In contrast, mint-flavoured ONP extracts elicited stronger TRPA1 irritant receptor responses than Chill extracts. Chemical analysis demonstrated that Chill exclusively contained WS-3, an odourless synthetic cooling agent, while mint-flavoured ONPs contained WS-3 together with mint flavourants.

CONCLUSIONS

ONP products marketed as 'Flavour-Ban Approved' or 'unflavoured' contain flavouring agents, proving that the manufacturer's advertising is misleading. Synthetic coolants such as WS-3 can provide a robust cooling sensation with reduced sensory irritancy, thereby increasing product appeal and use. Regulators need to develop effective strategies for the control of odourless sensory additives used by the industry to bypass flavour bans.

Content analysis of marketing features in US nicotine pouch ads from 2021 to 2023

INTRODUCTION

Since their 2016 US debut, nicotine pouches, which are available in various flavours and strengths, have grown in popularity. Nicotine pouches may appeal to people who use tobacco, but there is also concern that they may appeal to youth and non-nicotine users. This study analysed nicotine pouch advertising trends from 2021 to 2023 to explore advertising features and inform regulatory strategies.

METHODS

We conducted a content analysis of 2147 nicotine pouch print, radio, online/mobile, direct emails and social media ads from 2021 to 2023. Ads were coded for flavours, terms and claims. Two trained coders double-coded all ads, and any discrepancies were reconciled. We conducted χ2 and post-hoc tests to assess changes over time, using Bonferroni adjustments for multiple comparisons.

RESULTS

Most ads (84.6%) were posted on brands' social media accounts. Zyn ads comprised 54.5% of ads across media platforms. Most ads (72.3%) featured flavoured products, particularly fruit (27.1%) and mint (26.1%). Common terms included 'smoke-free' (19.2%), 'tobacco-free' (18.4%), 'synthetic' (12.9%) and 'spit-free' (10.6%), which all significantly declined from 2021 to 2023. The most common claim featured how convenient the product was to use, which significantly increased over time. Claims about product discreetness and the presence of coupons/discounts also significantly increased over time.

CONCLUSIONS

We observed a decline in terms of connecting nicotine pouches to other tobacco products and an increase in potentially youth-appealing convenience claims. Future research should investigate how these features impact risk perceptions and use intentions among people who never and currently use tobacco to inform regulations (ie, restrict youth-appealing claims).

Beyond Tobacco: Bridging Gaps in Social History Records for Tobacco-Free Nicotine Pouch Consumers

Objective

Nicotine-containing products have historically been tobacco derivatives like cigarettes, cigars, and dip. Recently, tobacco-free nicotine (TFN) products have been marketed as a healthy alternative. TFN pouches are small, discreet, flavored pouches containing nicotine designed to be placed between the gum and lip. This product does not fit a conventional tobacco category, leading to inaccurate reporting. This study aims to investigate discrepancies in physician documentation of TFN pouches.

Methods

A retrospective chart review was conducted on TFN users.

Setting

Single Health Care System.

Methods

Statistical analyses assessed TFN documentation concordance between social history templates and physician notes.

Results

There were 150 patients who used TFN and 841 patients who vaped. Concordance was higher for vape documentation than TFN pouch documentation (55.9%, 470/841 vs 25.3%, 38/150; P < .001). Of those who used TFN, 60% (90/150) were classified as "Smokeless Tobacco Users" in the social history; however, 35 were inaccurately classified as chew, and 17 did not specify TFN use. Only 38 specified TFN use; only 25% (38/150) of records demonstrated concordance.

Conclusion

Only 25% of records were concordant with physician notes, highlighting the need for a designated place for TFN use within social history templates. Nicotine use history is crucial in the setting of microvascular reconstruction and cosmetic surgeries. Thus, accurate reporting is crucial for future research on the long-term effects of TFN. This study's findings underscore a deficit in current social history templates and the need to recognize TFN pouches as distinct entities.

Awareness and use of nicotine pouches in a nationwide sample of adults in Poland

INTRODUCTION

Nicotine pouches are a new type of nicotine-containing product that have been marketed in many countries worldwide, generating growing acceptance among consumers. The aim of this study was to assess factors associated with public awareness and use of nicotine pouches among adults in Poland.

METHODS

A cross-sectional survey was conducted with a nationally representative sample of 1080 adults in Poland (February 2024). Awareness of nicotine pouches, history of use, current (past 30-day) use of nicotine pouches, as well as perception of harm was assessed using a purpose-designed questionnaire.

RESULTS

Awareness of nicotine pouches was reported by 24% of the sample, while 9.2% reported ever having used a nicotine pouch product, and 4.3% using a nicotine pouch in the past 30 days. Among all respondents, 60.7% perceived nicotine pouches as harmful as combustible cigarettes, 28.2% perceived nicotine pouches as less harmful, and 11% as more harmful than combustible cigarettes. In multivariable logistic regression model, women (adjusted odds ratio, AOR=1.40; 95% CI: 1.03-1.91; p<0.05), individuals aged <60 years (p<0.05), current tobacco smokers (AOR=2.59; 95% CI: 1.75-3.82; p<0.001), former tobacco smokers (AOR=1.53; 95% CI: 1.01-2.32; p<0.05) and ever users of e-cigarette or heated tobacco (AOR=2.90; 95% CI: 2.07-4.05; p<0.001) were more likely to declare that had ever heard of nicotine pouches. Moreover, individuals aged <60 years (p<0.05), occupationally active individuals (AOR=1.82; 95% CI: 1.01-3.31; p<0.05), current tobacco smokers (AOR=2.71; 95% CI: 1.48-4.97; p<0.01), and ever users of e-cigarette or heated tobacco (AOR=5.29; 95% CI: 2.96-9.44; p<0.001) were more likely to declare ever use of nicotine pouches.

CONCLUSIONS

This study provides the first national data on public awareness and use (ever and current) of nicotine pouches in Poland. Young adults, current smokers, and ever e-cigarette and heated tobacco users are at higher risk of ever use of nicotine pouches, so policy interventions are needed to protect young people from nicotine pouch marketing and nicotine initiation.

Self-assembled core-shell nanoparticles with embedded internal standards for SERS quantitative detection and identification of nicotine released from snus products

Surface enhanced Raman spectroscopy (SERS) is a unique analytical technique with excellent performance in terms of sensitivity, non-destructive detection and resolution. However, due to the randomness and poor repeatability of hot spot distribution, SERS quantitative analysis is still challenging. Meanwhile, snus is a type of tobacco product that can release nicotine and other components in the mouth without burning, and the rapid detection technique based on SERS can reliably evaluate the amount of nicotine released from snus, which is of great significance for understanding its characteristics and regulating its components. Herein, the strategy was proposed to solve the feasibility of SERS quantitative detection based on self-assembled core-shell nanoparticles with embedded internal standards (EIS) due to EIS signal can effectively correct SERS signal fluctuations caused by different aggregation states and measurement conditions, thus allowing reliable quantitative SERS analysis of targets with different surface affinity. By means of process control, after the Au nanoparticles (Au NPs) were modified with 4-Mercaptobenzonitrile (4-MBN) as internal standard molecules, Ag shell with a certain thickness was grown on the surface of the AuNP@4-MBN, and then the Au@4-MBN@Ag NPs were used to regulate and control the assembly of liquid-liquid interface. The high-density nano-arrays assembled at the liquid-liquid interface ensure high reproducibility as SERS substrates, and which could be used for SERS detection of nicotine released from snus products. In addition, time-mapping research shows that this method can also be used to dynamically monitor the release of nicotine. Moreover, such destruction-free evaluation of the release of nicotine from snus products opens up new perspectives for further research about the impact of nicotinoids-related health programs.

Nicotine and Cardiovascular Health: When Poison is Addictive - a WHF Policy Brief

Nicotine is universally recognized as the primary addictive substance fuelling the continued use of tobacco products, which are responsible for over 8 million deaths annually. In recent years, the popularity of newer recreational nicotine products has surged drastically in many countries, raising health and safety concerns. For decades, the tobacco industry has promoted the myth that nicotine is as harmless as caffeine. Nonetheless, evidence shows that nicotine is far from innocuous, even on its own. In fact, numerous studies have demonstrated that nicotine can harm multiple organs, including the respiratory and cardiovascular systems. Tobacco and recreational nicotine products are commercialized in various types and forms, delivering varying levels of nicotine along with other toxic compounds. These products deliver nicotine in profiles that can initiate and perpetuate addiction, especially in young populations. Notably, some electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) can deliver concentrations of nicotine that are comparable to those of traditional cigarettes. Despite being regularly advertised as such, ENDS and HTP have demonstrated limited effectiveness as tobacco cessation aids in real-world settings. Furthermore, ENDS have also been associated with an increased risk of cardiovascular disease. In contrast, nicotine replacement therapies (NRT) are proven to be safe and effective medications for tobacco cessation. NRTs are designed to release nicotine in a slow and controlled manner, thereby minimizing the potential for abuse. Moreover, the long-term safety of NRTs has been extensively studied and documented. The vast majority of tobacco and nicotine products available in the market currently contain nicotine derived from tobacco leaves. However, advancements in the chemical synthesis of nicotine have introduced an economically viable alternative source. The tobacco industry has been exploiting synthetic nicotine to circumvent existing tobacco control laws and regulations. The emergence of newer tobacco and recreational nicotine products, along with synthetic nicotine, pose a tangible threat to established tobacco control policies. Nicotine regulations need to be responsive to address these evolving challenges. As such, governments should regulate all tobacco and non-medical nicotine products through a global, comprehensive, and consistent approach in order to safeguard tobacco control progress in past decades.

The volatile release evaluation of nicotine from snus products under different storage conditions based on surface-enhanced Raman spectroscopy technology

Surface enhanced Raman spectroscopy (SERS) is a highly sensitive analytical detection technique that provides unique chemical and structural information on target molecules. Snus is a type of tobacco product that can release nicotine and other components under certain humidity and temperature without burning, and the evaluation of its nicotine release under different storage conditions is very important for understanding its characteristics, regulating its components, and setting reasonable storage conditions. Herein, by means of an artificial climate box and suction extraction device, the volatile release evaluations of nicotine from snus products under different storage conditions were performed based on Fe3O4 microparticles coated with Au nanorods and Au nanoparticles (Fe3O4@AuNRsNPs) as SERS substrates combined with a capillary. The Fe3O4@AuNRsNPs assemblies can be fixed in the inner wall of the capillary with the aid of an external magnetic field, which improved the maneuverability of the SERS substrates. By comparing the intensities of the spectral peaks of the symmetrical breathing of the pyridine moiety of nicotine molecules with increasing temperature and humidity, which could significantly accelerate the volatile release of a small amount of nicotine, the nicotine release under different conditions could be evaluated. Based on this strategy, it was possible to obtain the storage or placement conditions of the product. The results of this study provide a reference to clarify the volatile release of nicotine under various storage conditions, which is helpful for better regulation of the levels of nicotine in snus. Moreover, such destruction-free evaluation of the volatile release of nicotine from snus products under different storage conditions opens up new perspectives for further research about the impact of nicotinoids on smokers' health and cessation programs.