Flavored oral nicotine products, which do not contain tobacco but are not FDA-approved to help people quit smoking, are increasingly being marketed and sold in the United States, but researchers have not never measured their use among American adolescents.
In a new study, published this week in the journal Pediatrics, researchers at USC’s Keck School of Medicine surveyed more than 3,500 Southern California teenagers about the nicotine products they use. New flavored oral nicotine products rank second: 3.4% of teens have used them at least once, while 1.7% have used them in the past six months. E-cigarettes, also known as vapes, were the most popular nicotine product, with 9.6% of teens having used them at least once and 5.5% of teens having used them in the past six months. Cigarettes, cigars, hookah and other products were less popular.
“Surprisingly, these novel flavored oral nicotine products were the second most commonly used product among our sample, just behind e-cigarettes,” said study lead author Alyssa F. Harlow, PhD. , MPH, postdoctoral fellow in the Department of Population Sciences and Public Health at USC’s Keck School of Medicine.
Nicotine exposure during adolescence can impair brain development, cause problems with learning, memory and attention, and lead to nicotine addiction.
“Our findings are concerning because these products are often high in nicotine, which we know is harmful to teenagers, and they are really easy to hide and conceal. They also come in sweet flavors that may appeal to teens,” like “cherry bomb” and “mixed fruit,” Harlow said.
Prevalence and disparities
The research team collected data in 2021 as part of an ongoing study of the behavioral health of adolescents in Southern California. Participants included 3,516 ninth graders and 10e students at 11 high schools in Los Angeles, Riverside, San Bernardino, Orange and Imperial counties.
After e-cigarettes, oral nicotine products without tobacco flavor (gum, lozenges, tablets, and gummies) were the most commonly used products. Combustible tobacco products rank third, with 2% of teens reporting ever having used cigarettes, cigars, cigarillos, or hookah and 1.3% having used one or more of these items in the past six months. Less than 1% of teens had ever used other nicotine products, such as sachets or snus, or in the past six months. Use of flavored oral nicotine products was more common among adolescents who had also used other nicotine products, such as cigarettes or e-cigarettes.
The researchers also found that the use of flavored oral nicotine products was higher among Hispanic teens, teenage girls, and teens who identified as LGBTQ.
“Some of these subpopulations are young people who have historically been impacted by tobacco-related disparities,” Harlow said. “It is important for us to continue to monitor the use of these products among young people to determine the potential influence on these disparities.”
Monitoring of nicotine consumption
National surveys that monitor nicotine use among adolescents, including the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System and the Food and Drug Administration’s Tobacco Population and Health Assessment , do not yet follow the new flavored oral nicotine products. Given the popularity of these products in the current sample and the fact that they may appeal to young people, Harlow said it’s essential to track their popularity with teens and young adults.
“At the moment, we don’t really know what the public health implications are,” she said. “That’s why monitoring at the national level is really the first and most important step.”
Although these products can be harmful for young people, they offer a potentially less harmful alternative for adults looking to quit smoking or vaping. Harlow and his colleagues are studying young adult vapers to find out how the appeal of new flavored oral nicotine products compares to that of FDA-approved withdrawal products.
They are also continuing to collect data from the sample of Southern California high school students and plan to conduct longitudinal analyzes of nicotine use to determine how the use of flavored oral nicotine products may be linked to other behaviors, such as vaping and smoking, over time. .
About this study
Besides Harlow, the other study authors are Erin Vogel, Alayna P. Tackett, Junhan Cho, Dae-Hee Han, Melissa Wong, Myles G. Cockburn, Steve Y. Sussman, Jennifer B. Unger, Adam M. Leventhal and Jessica. L. Barrington-Trimis of the USC Institute for Addiction Science and the Department of Population Sciences and Public Health, USC Keck School of Medicine.
This work was supported by the National Cancer Institute and the Food and Drug Administration Center for Tobacco Products [U54CA180905]the national cancer institute [R01CA229617]National Institute on Drug Abuse [K24DA048160; K01DA042950] and the National Heart, Lung, and Blood Institute [K01HL148907].