Nicotine Strength Research Articles

Patterns of nicotine pouch use among young Australians

BackgroundDespite increasing interest in the use of nicotine pouches in Australia – where retail sale of the products is illegal – research exploring patterns of pouch use and reasons for use is lacking. Accordingly, this study explored young Australians’ experiences with nicotine pouches. MethodsAn online survey was administered to 1,598 Australians aged 16-39 years (53% women). We assessed (i) awareness and use (lifetime and past 30-day) of nicotine pouches, (ii) patterns of use (e.g., flavours and nicotine strength used), (iii) product source, and (iv) reasons for use. Regression analyses were conducted to assess socio-demographic predictors of awareness and use. ResultsJust over three-quarters (77%) of the sample reported being aware of nicotine pouches. Lifetime use was reported by 26% of respondents and past 30-day use by 19%. Among those who reported past 30-day use, fruit (35%) and menthol/mint (34%) flavours were most common. In terms of pouch source, one-third (33%) reported obtaining the product from a tobacconist. The most common reasons for use were “they come in flavours I like” (34%) and “to help me quit smoking” (32%). Awareness, lifetime use, and past 30-day use of nicotine pouches were more likely among men, those who reported current use of tobacco products, and those who reported current use of e-cigarettes. ConclusionsAwareness and use of nicotine pouches among young Australians may be substantial enough to warrant the inclusion of items measuring pouch use in national surveys. Efforts should be made to better enforce existing laws regarding the sale of nicotine pouches.

The association between smoking/vaping habits and self-reported respiratory symptoms.

Smoking is well known for its harmful effect on the respiratory system, but whether vaping is less harmful is unknown. Therefore, the aim of this study was to assess the association of smoking/vaping habits with self-reported respiratory symptoms in vapers and cigarette smokers. An online survey was developed and shared on different vaping and smoking social media platforms and communities. Out of the 891 respondents, 788 were vapers (77 pure vapers and 711 ex-smokers) and 103 were cigarette smokers. Smokers reported more frequently respiratory symptoms such as chest pain, wheezing and whistling, sputum production, cough, dry mouth, and smokers suffered from more shortness of breath, sore throat and disturbed sleep compared to vapers. The self-reported respiratory symptoms in vapers were mainly related to the nicotine strength of the product and number of puffs per use. There were no significant differences between pure vapers and vapers who were ex-smokers. Self-reported severe respiratory symptoms were less frequent in vapers than smokers, irrespective of their smoking history. This suggests that vaping is less harmful than cigarette smoking.

A content analysis of nicotine descriptors on the front of vape packaging in the United Kingdom.

The Tobacco and Related Products Regulations (TRPR) 2016 require consumers in the United Kingdom (UK) to be informed about the presence of nicotine in vaping products. However, there is misunderstanding among some young people and adults around the strength of products. We examined how nicotine content is displayed on the front of vape packaging in the UK. Between August and December 2022, we systematically analysed a representative, stratified selection of vapes and refill packs (n=156) on the UK market to assess TRPR compliance. This paper presents an analysis of free-text responses collected to indicate the presence of nicotine information on the front-of-pack including metric, percentage, graphic, and text indicators. Data were analysed using descriptive statistics produced for the sample as a whole and for five product categories. Most packs (n=126, 81%) displayed at least one front-of-pack nicotine descriptor, including the majority of disposables (n=43, 90%), e-liquid (n=42, 88%) and refill pods (n=36, 100%). Many packs (n=107, 69%) contained a nicotine-related metric (e.g. mg/ml), a quarter (n=37, 24%) included a percentage indicator and most (n=126, 81%) displayed at least one of these. Almost two-fifths (n=57, 37%) mentioned nicotine beyond the warning. Less observed indicators included graphic and textual depictions of strength, dosage information, and equivalent number of cigarettes. The front of vape packaging communicates important product information to consumers. There is inconsistency in how nicotine content is currently displayed. Future research should examine how best to display nicotine content to promote consumer understanding and informed decision-making. This pack analysis of a representative sample of UK vape packaging highlights the varied way in which nicotine content and strength is currently communicated to consumers on the front of vape packaging. The inconsistent presentation of nicotine content on the front of packs may contribute to misperceptions around product strength. A consistent and easily understood way of communicating nicotine content on the front of vape packaging may help consumers make more informed choices about vape products.

Nicotine strength of e-liquids used by adult vapers in Great Britain: A population survey 2016 to 2024.

In March 2024, the UK government announced plans to introduce a Vaping Products Duty that will tax e-liquids based on their nicotine strength. This study examined trends in the nicotine strength of e-liquids used by adult vapers and differences in those currently used across relevant subgroups. Nationally-representative, cross-sectional household survey, July 2016 to January 2024. Great Britain. 7981 adult vapers. Participants were asked whether the e-cigarette they mainly use contains nicotine (yes/no) and the e-liquid strength (no nicotine, >0-≤ 6, 7-11, 12-19 or ≥20 mg/ml). We also collected information on the main device type used (disposable/refillable/pod), age, gender, occupational social grade, history of ≥1 mental health conditions, smoking status and (among past-year smokers) level of cigarette addiction. The proportion of vapers in England using high-strength (≥20 mg/ml) e-liquids increased from an average of 3.8% (95% confidence interval [CI] = 2.9-5.0) up to June 2021 to 32.5% (CI = 27.9-37.4) in January 2024 (the vast majority of whom [93.3% in January 2024] reported using exactly 20 mg/ml; the legal limit). This rise was most pronounced among those using disposable e-cigarettes, those aged 18-24 years and all smoking statuses (including never smokers) except long-term (≥1y) ex-smokers. Of those surveyed in 2022-2024 in Great Britain, overall, 89.5% (CI = 88.1-90.8) said they usually used e-cigarettes containing nicotine, 8.7% (CI = 7.5-10.0) used nicotine-free e-cigarettes, and 1.8% (CI = 1.2-2.4) were unsure. The proportion using ≥20 mg/ml was higher among those mainly using disposable (47.9%) compared with pod (16.3%) or refillable (11.5%) devices; never smokers (36.0%), current smokers (28.8%) or recent (<1y) ex-smokers (27.4%), compared with long-term ex-smokers (13.9%); and younger (16-24y; 44.2%) compared with older (≥25y; range 9.4-25.1%) age groups. There were no notable differences across other subgroups of interest. Use of high-strength nicotine e-liquids in England appears to have increased sharply in recent years. Most adult vapers in Great Britain appear to use e-cigarettes that contain nicotine but different subgroups use different strengths: nicotine strengths tend to be higher among those who mainly use disposable devices and those aged 16-24y, and lower among long-term ex-smokers.

An exploratory, randomised, crossover study to investigate the effect of nicotine on cognitive function in healthy adult smokers who use an electronic cigarette after a period of smoking abstinence

BackgroundAs well as being associated with serious negative health outcomes, smoking has been reported to have an array of physiological and psychological effects, including effects on mood and cognitive function. Post-cessation, loss of such effects (including temporary deficits in cognitive function) have been cited as reasons for resumption of smoking. The effects of e-cigarettes and nicotine delivered by e-cigarettes on these functions have not been widely researched but may play a role in the effectiveness of e-cigarettes as a satisfactory alternative to combustible cigarettes for people who smoke, and in encouraging individuals who would otherwise continue to smoke, to transition to e-cigarettes.MethodsThe study was an exploratory, randomised, partially-blinded, single-centre, five-arm crossover trial that recruited 40 healthy male and female people who smoke. At 5 study sessions, following a 12-h period of nicotine abstinence, participants were randomly assigned to use either a combustible cigarette, an e-cigarette of three varying nicotine strengths (18 mg/mL, 12 mg/mL or 0 mg/mL respectively) or observe a no product usage session. Participants completed pre- and post-product usage assessments to examine the product usage effect on cognitive performance (using the Cambridge Neuropsychological Test Automated Battery (CANTAB)), subjective mood and smoking urges.ResultsA significant improvement in sustained attention task performance was observed following use of both the nicotine containing e-cigarettes and combustible cigarette compared to no product use. Additionally, there were no significant differences between the nicotine containing products, indicating that nicotine use enhanced sustained attention regardless of delivery format. Nicotine containing e-cigarette and combustible cigarette use also significantly improved overall mood of participants compared to no product use, with no significant differences observed between the nicotine containing products. Nicotine containing e-cigarette and combustible cigarette use significantly reduced smoking urges compared to no product use, though combustible cigarette use elicited the greatest reduction in smoking urges.ConclusionsOverall, the nicotine containing products improved sustained attention and mood while reducing smoking urges, with the studied e-cigarettes having comparable effects to combustible cigarettes across the assessed cognitive parameters and mood measures. These results demonstrate the potential role of e-cigarettes to provide an acceptable alternative for combustible cigarettes among people who would otherwise continue to smoke.Trial registration ISRCTN (identifier: ISRCTN35376793).

Nicotine-related beliefs induce dose-dependent responses in the human brain.

Beliefs have a powerful influence on our behavior, yet their neural mechanisms remain elusive. Here we investigate whether beliefs could impact brain activities in a way akin to pharmacological dose-dependent effects. Nicotine-dependent humans were told that nicotine strength in an electronic cigarette was either 'low', 'medium' or 'high', while nicotine content was held constant. After vaping, participants underwent functional neuroimaging and performed a decision-making task known to engage neural circuits affected by nicotine. Beliefs about nicotine strength induced dose-dependent responses in the thalamus, a key binding site for nicotine, but not in other brain regions such as the striatum. Nicotine-related beliefs also parametrically modulated the connectivity between the thalamus and ventromedial prefrontal cortex, a region important for decision-making. These findings reveal a high level of precision in the way beliefs influence the brain, offering mechanistic insights into humans' heterogeneous responses to drugs and a pivotal role of beliefs in addiction.

Demand for E-Cigarettes Based on Nicotine Strength: Evidence from Retail Sales

Demand for E-Cigarettes Based on Nicotine Strength: Evidence from Retail Sales

A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study.

There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire-the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products ("vapers cohort"; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products ("controls cohort"; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the "vapers cohort" will be compared with those of people in the "controls cohort." Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. DERR1-10.2196/54236.

Bigger, stronger and cheaper: growth in e-cigarette market driven by disposable devices with more e-liquid, higher nicotine concentration and declining prices

ObjectiveGiven the evolving changes in the disposable e-cigarette market, we explore patterns of sales in the USA by e-liquid volume capacity, nicotine strength and real sales-weighted average prices by both...

E-cigarette support for smoking cessation: Identifying the effectiveness of intervention components in an on-line randomized optimization experiment.

The aim of this study was to determine which combination(s) of five e-cigarette-orientated intervention components, delivered on-line, affect smoking cessation. An on-line (UK) balanced five-factor (2 × 2 × 2 × 2 × 2 = 32 intervention combinations) randomized factorial design guided by the multi-phase optimization strategy (MOST) was used. A total of 1214 eligible participants (61% female; 97% white) were recruited via social media. The five on-line intervention components designed to help smokers switch to exclusive e-cigarette use were: (1) tailored device selection advice; (2) tailored e-liquid nicotine strength advice; (3): tailored e-liquid flavour advice; (4) brief information on relative harms; and (5) text message (SMS) support. The primary outcome was 4-week self-reported complete abstinence at 12 weeks post-randomization. Primary analyses were intention-to-treat (loss to follow-up recorded as smoking). Logistic regressions modelled the three- and two-way interactions and main effects, explored in that order. In the adjusted model the only significant interaction was a two-way interaction, advice on flavour combined with text message support, which increased the odds of abstinence (odds ratio = 1.55, 95% confidence interval = 1.13-2.14, P = 0.007, Bayes factor = 7.25). There were no main effects of the intervention components. Text-message support with tailored advice on flavour is a promising intervention combination for smokers using an e-cigarette in a quit attempt.

Marketing claims on the websites of leading e-cigarette brands in England

IntroductionExposure to electronic cigarette (EC) marketing is associated with EC use, particularly among youth. In England, the Tobacco and Related Products Regulations and Committee of Advertising Practice (CAP) regulate EC...

Purchase Intent and Product Appeal of Velo Nicotine Pouches Among Current Tobacco Users and Nonusers of Tobacco

Summary Background and objectives Oral nicotine pouches is a rapidly growing product category that potentially offers less risk than combustible tobacco products. Nicotine pouches may provide harm reduction for smokers because they contain no tobacco and have reduced harmful constituents compared to traditional tobacco product categories. Any potential public health benefit must weigh the likelihood that current tobacco users will switch to the lower-risk product against the likelihood that nonusers will start using tobacco products. To our knowledge, no existing studies provide population-level estimates of purchase intent or product appeal across tobacco user groups or how product characteristics might affect those variables. Methods This paper presents population-level estimates of purchase intent and product appeal for multiple Velo nicotine pouch products (including different flavors, nicotine strengths, format, and packaging) among five adult tobacco user groups (current established cigarette smokers, current established non-cigarette tobacco users, current tobacco experimenters, former tobacco users, and never ever tobacco users). Over 49,000 respondents were surveyed across twelve analytic samples. Results Results for the pooled sample as well as for each individual sample were remarkably consistent for every product. Ratings of purchase intent and appeal are higher for current tobacco users (current established cigarette smokers, current established non-cigarette tobacco users, and current tobacco experimenters) than for former and never ever tobacco users. Conclusions and scientific significance Variation in product characteristics had little or no effect on purchase intent or appeal ratings across tobacco user groups, suggesting that product characteristics do not materially affect public health.

Evaluation of Statewide Restrictions on E-Cigarette Nicotine Strength- United States, 2017-2022.

To evaluate statewide policies restricting e-cigarette nicotine strength. A difference-in-difference regression analysis was used to compare e-cigarette sales in states that restrict nicotine strength with states with no restrictions. Since flavor restrictions might affect sales and nicotine strength, states with flavor restrictions were also assessed. United States e-cigarette retail sales data during January 2017-March 2022 were licensed from Information Resources Incorporated. States with restrictions included Massachusetts (restricted maximum nicotine strength to 3.5% and non-tobacco flavored e-cigarette sales in December 2019); Utah (restricted nicotine strength to 3.6% in September 2021); and Rhode Island, New York, and Washington (restricted non-tobacco flavor sales in October 2019, May 2020, and October 2019-January 2020 respectively). These were compared with data from 34 states with no e-cigarette nicotine strength or flavor restrictions MEASUREMENTS: Weighted mean nicotine strength and total unit sales. Total unit sales per 1,000 state population were summed into 4-week periods by state. Models controlled for emergency responses, state demographics, tobacco control policies, time, and state fixed effects. Restricting both nicotine strength and flavors in Massachusetts was associated with a 2.04 percentage point (pp) reduction in mean nicotine strength and 86.76-unit reduction in monthly unit sales per 1,000 persons compared with states with no restrictions (all p<0.01). Restricting nicotine strength only in Utah was associated with a 1.77 pp (p<0.01) reduction in mean nicotine strength; however, there was no impact on unit sales. Restricting non-tobacco flavor sales only in Rhode Island, New York, and Washington slightly reduced mean nicotine strength (0.21, 0.62, and 0.19 pp, respectively) and sales (36.66, 34.51, and 16.37 units, respectively) (all p<0.01). US statewide policies restricting e-cigarette nicotine strength appear to be associated with reductions in average nicotine strength in sales within that state; however, there appears to be no impact on unit sales. When these policies are implemented along with flavor restrictions; reductions in average nicotine strength occur in addition to reduced unit sales.

Nicotine Intake in Adult Pod E-cigarette Users: Impact of User and Device Characteristics.

This study examined user behavior, e-cigarette dependence, and device characteristics on nicotine intake among users of pod-mod e-cigarettes. In 2019-2020, people who use pod-mods in the San Francisco Bay Area completed questionnaires and provided a urine sample for analysis of total nicotine equivalents (TNE). The relationship between TNE and e-cigarette use, e-cigarette brands, e-liquid nicotine strength, e-cigarette dependence, and urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), as a measure of combustible cigarette exposure, were examined. Of 100 participants (64% male, 71% in the 18-34 age group, 45% white), 53 used JUUL primarily, 12 used Puff Bar primarily, and 35 used other brands, including Suorin; 48 participants reported current cigarette smoking. Participants most often reported use of e-liquid with 4.5%-6.0% nicotine (68%), fruit (35%), tobacco (28%), and menthol or mint flavors (26%), used e-cigarettes on 25.5 (SD = 6.3) days a month, 10.2 (SD = 14.2) times a day, and 40% used 1-2 pods/cartridges per week. In bivariate analysis, urinary TNE was higher with greater frequency (days used) and intensity (number of pods used) of e-cigarette use, e-cigarette dependence, and combustible cigarette use. In multivariable analysis, days of e-cigarette use in the last 30 days, number of pods used per week, and NNAL levels were significantly associated with TNE. There was no significant impact of e-liquid nicotine strength on TNE. Nicotine intake among people who used pod-mod e-cigarettes increased with e-cigarette consumption and e-cigarette dependence, but not with e-liquid nicotine strength. Our findings may inform whether FDA adopts a nicotine standard for e-cigarettes. The study examined how device and user characteristics influence nicotine intake among pod-mod e-cigarette users. Nicotine intake increased with frequency (days of e-cigarette use in past 30 days) intensity of use (number of pods used per day) and e-cigarette dependence but not with the flavor or nicotine concentration of the e-liquids. Regulation of nicotine concentration of e-liquids is unlikely to influence nicotine exposure among adult experienced pod-mod users.

Nicotine-related content in English language ENDS advertisements in the US: 2018–2020

There is no standard way to communicate to consumers how much nicotine is present in electronic nicotine delivery systems (ENDS). This study assessed the inclusion of nicotine-related content, including nicotine strength, in a sample of English language ENDS advertisements that appeared in consumer and business-to-business outlets in the US during 2018–2020.The sample, provided by a media surveillance company, included ads from television, radio, newspapers, magazines (consumer and business-to-business), online platforms, outdoor/billboards, and direct-to-consumer emails. We coded for the presence of nicotine-related content (excluding FDA-required warnings) including nicotine strength presentation, such as mg, mg/ml and percent.The sample included 2966 unique ads, of which 33% (n = 979) featured nicotine-related content. The proportion of ads in the entire sample with nicotine-related content differed by manufacturer/retailer. Ads for Logic e-cigarettes had the highest proportion of nicotine content (62%, n = 258), while ads for JUUL and Vapor4Life had the lowest proportion (13.0% (n = 95) and 19.8% (n = 65), respectively). The proportion of ads with nicotine-related content also differed by media outlet: B2B magazines: 64.8% (n = 68); emails: 41% (n = 529); consumer magazines: 30.4% (n = 41); online: 25.3% (n = 227); television: 20% (n = 6); radio: 19.1% (n = 89); and outdoor (0%, n = 0). Across the sample of ads, 15% reported nicotine strength in mg or mg/ml (n = 444), and 9% reported nicotine strength in percent (n = 260).Most ENDS ads do not include nicotine-related content. There is substantial variation in presentation of nicotine strength, which may present challenges for consumer understanding of absolute and relative nicotine-related content.

Trends in Nicotine Strength in Electronic Cigarettes Sold in the United States by Flavor, Product Type, and Manufacturer, 2017-2022.

Most e-cigarettes contain highly addictive nicotine. This study assessed trends in nicotine strength in e-cigarettes sold in the United States during January 2017-March 2022. We obtained January 2017-March 2022 national retail e-cigarette sales data from NielsenIQ. We assessed monthly average nicotine strength overall, by e-cigarette product and flavor type, and manufacturer. A Joinpoint regression model assessed the magnitude and significance of changes in nicotine strength. During January 2017-March 2022, monthly average nicotine strength of e-cigarette products increased from 2.5% to 4.4%, an average of 0.8% per month (p < .001). Monthly average nicotine strength of disposable e-cigarettes increased the most (average monthly percentage change [AMPC] = 1.26%, p < .001) as compared to prefilled pods (AMPC = 0.6%, p < .001) and e-liquids (AMPC = 0.5%, p = .218). Monthly average nicotine strength for all flavors of e-cigarette products increased except for mint-flavored products. Increases were greatest for beverage-flavored products (AMPC = 2.1%, p < .001), followed by menthol-flavored products (AMPC = 1.2%, p < .001). Among the top 10 e-cigarette manufacturers assessed, monthly average nicotine strength decreased for Juul Labs products from 5% to 4.7% (AMPC = -0.1%, p < .001) but increased significantly for five manufacturers' products and remained unchanged at 5%-6% for four manufacturers' products. Monthly average nicotine strength of e-cigarette products increased overall, for most product and flavor types, and for some manufacturers in the United States during the study period. Imposing maximum limits on nicotine strength of e-cigarettes together with other evidence-based tobacco control strategies can help reduce the use of e-cigarettes among youth and increase tobacco product cessation among adults. From January 2017 to March 2022, the monthly average nicotine strength of disposable e-cigarettes increased substantially and exceeded prefilled pods since May 2020. E-cigarettes with menthol flavor and youth-appealing flavors, like fruit, also had sharp increases in monthly average nicotine strength. Among the top 10 e-cigarette manufacturers, monthly average nicotine strength increased or remained unchanged at a high nicotine level for all manufacturers' products, except Juul Lab's products. Comprehensive strategies including restricting sales of all flavored e-cigarettes, restricting youth tobacco product access, and imposing maximum limits on nicotine strength may help reduce youth e-cigarette use and increase tobacco cessation.

Current Knowledge and Challenges of Particle Size Measurements of Mainstream E-Cigarette Aerosols and Their Implication on Respiratory Dosimetry

The E-cigarette has been promoted as an alternative nicotine delivery device with potentially fewer toxicant emissions. The objective of this review is to summarize the current knowledge on the particle size distribution (PSD) of e-cigarette emissions and to analyze the knowledge gaps between existing particle size measurements and the vision toward harm reduction from e-cigarette use. Here, we focus on firstly describing the physical parameters used to characterize PSD, followed by comparing particle size measurement approaches, investigating the factors that impact the PSD of e-cigarette mainstream aerosols, and conclude by linking size distribution to the respiratory dosimetry by demonstrating the modeling results of particle deposition in the respiratory tract. This review calls for a harmonized testing protocol to conduct inter-comparisons and further understand e-cigarette particle sizes. Among the influencing factors investigated, puff topography, operation power, flavorings, PG/VG ratio, and nicotine strength impose a substantial impact on the PSD, but the underlying mechanisms have not yet been fully investigated. The effects brought by the type of device refill and nicotine are yet inconclusive due to lack of evidence. Coil aging has no significant impact on the PSD of e-cigarette aerosols within the coil lifetime. Lastly, while computational models of particle deposition have been adopted to profile the deposition of e-cigarette mainstream emissions, existing models have limited applicability and generality when dealing with e-cigarette aerosols that have high volatility and hygroscopicity, which can dynamically evaporate or grow during the transport process. Additionally, the size-dependent chemical composition (e.g., nicotine and harmful and potentially harmful constituents) of e-cigarette aerosols is unknown, impeding the understanding of the health effects of e-cigarette use. Therefore, it is essential for future studies to bridge these knowledge gaps and unveil the mechanisms determining PSD and respiratory deposition.

Use, marketing, and appeal of oral nicotine products among adolescents, young adults, and adults

ImportanceOral nicotine products such as pouches, lozenges, tablets, gums, and toothpicks are gaining popularity, especially among adolescents and young adults, with increased marketing. ObjectiveTo estimate use patterns of oral nicotine products and likelihood of buying and liking products based on marketing, using a large group of adolescents, young adults, and adults. Design, setting, and participantsA cross-sectional, online survey among U.S. participants (n = 6,131; ages 13–40 years) was conducted in November-December 2021. Main outcomes and measuresEver, past-30-day, and past-7-day use, behaviors, and flavors of oral nicotine products. Liking marketing and likelihood of buying specific oral nicotine products (Zyn pouches and Lucy gum) from marketing. ResultsOur sample included 2,025 (33.0%) ever-users, 1,191 (19.4%) past-30-day users, and 998 (16.3%) past-7-day users of any oral nicotine product. Use patterns by age (in years): ever-users (<21: 816 (22.3%); 21–40: 1,209 (48.9%)); past-30-day users (<21: 458 (12.5%); 21–40: 733 (29.7%)); and past-7-day users (<21: 383 (10.5%); 21–40: 615 (24.9%)). Across products, 10–18% of participants reported using nicotine strength ranging from 6–10 mg. Fruit, sweet/dessert, alcohol, coffee, and mint were the most used flavors. When shown marketing, ever-users liked and were likely to buy Zyn pouches compared to never users, and participants under 21 years felt equally targeted by Lucy and Zyn marketing. Liking Zyn marketing even a little bit compared to not at all increased the likelihood of buying Zyn pouches across age groups. After observing marketing, participants < 21 years were more likely to buy Zyn if they perceived marketing to contain messages about good tasting flavors (AOR 1.43, 1.09–1.87; 0.009) and helping to feel comfortable in social situations (AOR 1.38, 1.02–1.87; 0.033), and were more likely to buy Lucy if they felt it could be used anywhere (AOR 1.57, 1.05–2.33; 0.026). ConclusionsThis study provides a foundation for estimating use, behaviors, flavors, and marketing influence of oral nicotine products in the US and globally. Adolescent and young adult use of oral nicotine products and likelihood of buying products when exposed to marketing highlights the need for expanded tobacco use surveillance, marketing regulations, and counter marketing and educational efforts.

A Novel Puff Recording Electronic Nicotine Delivery System for Assessing Naturalistic Puff Topography and Nicotine Consumption During Ad Libitum Use: Ancillary Study.

Assessing the naturalistic puff topography and associated nicotine consumption during e-cigarette use is important as such information will not only unveil how these products are being consumed in real-world conditions, but also enable investigators and regulatory bodies to conduct quantitative, accurate, and realistic harmful exposure and nicotine abuse liability risk assessments based on actual e-cigarette use. Conventional approaches cannot accurately, conveniently, and noninvasively determine e-cigarette puff topography in a natural use environment. Thus, novel technology-enabled systems that do not primarily rely on self-report mechanisms or intrusive measurements to monitor e-cigarette product use behaviors are highly desired. This study aimed to explore and demonstrate the feasibility of a novel puff recording electronic nicotine delivery system (PR-ENDS) device for measuring naturalistic puff topography and estimating nicotine consumption during the ad libitum use of products among smokers and vapers. An ancillary data analysis based on a completed parent study was conducted. The parent study was a 1-way randomized controlled open-label puff topography and nicotine pharmacokinetic assessment carried out in 24 healthy adults (12 smokers and 12 vapers). Participants were assigned a randomized product use sequence of a PR-ENDS device within 5 site visits for both controlled and ad libitum product use sessions. Blood samples were obtained for plasma nicotine analysis, and questionnaires were administered at various time points. During the ad libitum use session, puff topography was measured using a Clinical Research Support System (CReSS) device as a benchmark, as well as the PR-ENDS device with a built-in puff recording feature. There were no significant differences in representative puff topography parameters (number of puffs, total puff duration, and average puff duration) between the PR-ENDS and CReSS devices at the populational level across different device powers, e-liquid nicotine strengths, and flavors. The nicotine consumption estimated by the PR-ENDS device suggested that this device can be employed as a convenient monitoring tool for estimating nicotine use without measuring e-liquid weight loss between puffs. The linear relationship between nicotine consumption estimated by the PR-ENDS device and the pharmacokinetic parameter AUCad lib (plasma concentration-time curve for 1-hour ad libitum use) substantiated the potential of using this device as a pragmatic, noninvasive, and convenient means for estimating nicotine intake in the human body without blood collection. The novel PR-ENDS device was feasible for assessing naturalistic puff topography and estimating nicotine consumption and intake in the human body during ad libitum use. Several key factors can influence users' puff topography, including device power levels, e-liquid nicotine strengths, and flavors. The study results pave the way for further research in the real-time measurement of naturalistic puff topography and puffing behaviors in the real world.

Trends in US E-cigarette Sales and Prices by Nicotine Strength, Overall and by Product and Flavor Type, 2017-2022.

The e-cigarette market has expanded considerably in recent years, resulting in changes in availability and use of e-cigarettes with varying characteristics. This study assessed trends in sales and prices of e-cigarettes by nicotine strength level, including by product type and flavor, during January 2017-March 2022. US e-cigarette retail sales data were licensed from IRI company. Nicotine strength was categorized as: <1%; 1% to <2%; 2% to <3%; 3% to <4%; 4% to <5%; ≥5%. E-cigarette flavors were categorized as tobacco, menthol, mint, or other flavors. Product type was categorized as prefilled cartridge devices, disposable devices, or e-liquid bottles. Trend analyses were performed using Joinpoint Regression. During January 2017-March 2022, the unit share of products containing ≥5% nicotine strength increased by 1486.3%, while the dollar share increased by 1345.5%. By March 2022, 80.9% of total unit sales were composed of products containing ≥5% nicotine strength. By flavor, the percentage of units sold with ≥5% nicotine strength was 61.3% of tobacco-flavor sales, 79.3% of menthol sales, 87.4% of mint sales, and 96.1% of other flavor sales. By product type, the percentage of units sold with ≥5% nicotine strength was 90.6% of disposable e-cigarette sales and 74.2% of prefilled cartridge sales. During January 2017-March 2022, the price of low-nicotine strength e-cigarettes increased, while the price of high-nicotine products either decreased or did not change. Sales of high nicotine-strength e-cigarettes have dominated the US e-cigarette market. Limiting the nicotine strength of e-cigarettes could be considered as part of a comprehensive tobacco control strategy to reduce youth access to and use of these products. The findings from this study indicate that previously reported increases in e-cigarette nicotine strength during 2013-2018 have continued through 2022. The US e-cigarette market sales continue to be dominated by relatively high-nicotine products. Strategies to address factors that make these products, particularly appealing to youth, including flavors and product innovations, are critical. Such strategies are important-as part of a comprehensive approach alongside other evidence-based population-level actions-to address youth e-cigarette use. Importantly, actions to reduce e-cigarette use among youth are not mutually exclusive from actions to maximize the potential benefits of e-cigarettes for increasing smoking cessation among adults.