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Avila JC, Maglalang DD, Nollen N, Lee SC, Suh R, Malone M, Binjrajka U, Ahluwalia JS. Using pod based e-cigarettes and nicotine pouches to reduce harm for adults with low socioeconomic status who smoke: A pilot randomized controlled trial. Nicotine Tob Res 2024:ntae047. [PMID: 38447095 DOI: 10.1093/ntr/ntae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Alternative Nicotine Delivery Systems (ANDS) such as e-cigarettes (EC) and oral nicotine pouches (ONP) may facilitate the substitution of smoking for those unwilling to quit. This pilot study assesses the harm reduction potential of EC and ONP among smokers with low socioeconomic status (SES). METHODS Adults who smoked daily in the past 6 months, had a household income < 250% federal poverty level and had no intention of quitting smoking in the next 30 days were randomized 2:2:1 to 8 Weeks of 5% nicotine EC; 4mg ONP or assessment-only control (CC). The primary outcome was a within-group change in cigarettes per day (CPD) from Baseline to Week 8. RESULTS 45 individuals were randomized (EC: N=18; ONP: N=18; CC: N=9). Analyses included 33 participants who completed the Week 8 visit. Mean age was 50.2 years (SD:10.7) and average CPD at baseline was 13.9 (SD: 10.1). For those randomized to EC, average CPD decreased from 14.7 (95%CI: 10.3; 19.1) at Baseline to 2.9 (95%CI: 0.09; 5.79) at Week 8 (p-value <0.001). For those randomized to ONP, average CPD decreased from 15.0 (95%CI: 5.02; 24.93) to 8.3 (95%CI: 1.34; 15.18) by Week 8 (p-value =0.01). In the EC and ONP groups, respectively, 4 (28.6%) and 1 (8.3%) participant fully switched from smoking to the ANDS product by Week 8. CONCLUSIONS Individuals with low SES who smoke had lower CPD after switching to EC or ONP. These findings show the potential of ANDS in helping smokers switch to less harmful devices. IMPLICATIONS This study provides novel evidence that e-cigarettes and nicotine pouches can be a harm reduction tool for individuals with lower SES who smoke and are not willing to quit smoking, contributing to reducing tobacco-related disparities in this population.
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Affiliation(s)
- Jaqueline C Avila
- Department of Gerontology, University of Massachusetts Boston, Boston, MA
| | - Dale Dagar Maglalang
- Silver School of Social Work, New York University, New York, NY
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Nicole Nollen
- Department of Population Health, School of Medicine, University of Kansas Medical Center
| | - Sangah Clara Lee
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Riley Suh
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Mona Malone
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Urvi Binjrajka
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Jasjit S Ahluwalia
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
- Warren Alpert School of Medicine, Brown University
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Tosakoon S, Romm KF, Berg CJ. Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States. Tob Prev Cessat 2023; 9:19. [PMID: 37293565 PMCID: PMC10246475 DOI: 10.18332/tpc/163243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/07/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Nicotine pouches, which emerged in the US in 2016 and are marketed as 'tobacco-free', may appeal to young adults. This study examined young adults' nicotine pouch awareness, use, use intentions, and related factors. METHODS We analyzed Spring 2022 survey data from 942 young adults recruited via social media from six US cities (mean age=27.61 years, 34.3% men, 33.1% racial/ethnic minority) to characterize nicotine pouch awareness, ever use, use intentions, exposure, and perceptions. RESULTS Nicotine pouch awareness and ever use were reported by 34.6% and 9.8%, respectively. Males (AOR=1.79; 95% CI: 1.33-2.38), non-White participants (vs White; AOR=1.64; 95% CI: 1.04-2.61), and those using cigarettes (AOR=2.67; 95% CI: 1.63-4.38), e-cigarettes (AOR=2.28; 95% CI: 1.57-3.31), and smokeless tobacco (SLT) (AOR=14.46; 95% CI: 1.81-115.61) had greater odds of awareness. Among those aware of nicotine pouches, males (AOR=2.27; 95% CI: 1.33-3.85), White participants (vs Asian; AOR=0.40; 95% CI: 0.17-0.94), and SLT users (AOR=4.90; 95% CI: 1.26-18.98) had greater odds of ever use; being male (B=0.39; 95% CI: -0.67 - -0.12) and using SLT (B=1.73; 95% CI: 1.10-2.36) predicted greater use intentions. Overall, 31.4% reported past-month advertising exposure, most often via tobacco retailers (67.3%). Ever users most commonly purchased them at gas stations (46.7%). The most frequently reported use motives were to quit combusted tobacco (16.8%) and reduce tobacco smell (15.4%). Nicotine pouches were perceived as less harmful and less addictive than cigarettes, e-cigarettes, and SLT, and more socially acceptable than cigarettes and SLT. CONCLUSIONS Young adults were exposed to advertising, accessed nicotine pouches via various sources, and perceived these products favorably. Marketing and use surveillance is needed to monitor their impact on those likely to use them (e.g. males, SLT users).
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Affiliation(s)
- Sararat Tosakoon
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, United States
| | - Katelyn F. Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, United States
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, United States
| | - Carla J. Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, United States
- George Washington Cancer Center, George Washington University, Washington, United States
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Azzopardi D, Haswell LE, Frosina J, McEwan M, Gale N, Thissen J, Meichanetzidis F, Hardie G. Assessment of biomarkers of exposure and potential harm, and physiological and subjective health measures in exclusive users of nicotine pouches and current, former and never smokers. Biomarkers 2023; 28:118-129. [PMID: 36484137 DOI: 10.1080/1354750x.2022.2148747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Oral nicotine pouches (NPs) are smokeless, tobacco-free products that have a potential role in tobacco harm reduction strategies.Methods: In a cross-sectional study in Sweden/Denmark, several recognised biomarkers of potential harm (BoPHs) linked to smoking-related diseases/their initiating biological processes, and biomarkers of exposure (BoEs) to tobacco/tobacco smoke toxicants were compared among exclusive adult users of Velo NPs and current/former/never smokers. Over 24 h, participants used their usual product (Velo NP or cigarette) as normal, and BoEs/BoPHs were assessed via blood/24-h urine/exhaled breath/physiological assessments.Results: Among the primary endpoints, total NNAL (16.9 ± 29.47 vs 187.4 ± 228.93 pg/24 h), white blood cell count (5.59 ± 1.223 vs 6.90 ± 1.758 × 109/L), and COHb (4.36 ± 0.525 vs 8.03 ± 2.173% saturation) were significantly lower among Velo users than among smokers (91%, 19% and 46% lower, respectively, all P < 0.0001), while fractional exhaled NO, previously shown to be lower in smokers, was significantly higher (23.18 ± 17.909 vs 11.20 ± 6.980 ppb) among Velo users (107% higher, P < 0.0001). Furthermore, sICAM-1 tended to be lower (185.9 ± 42.88 vs 204.5 ± 64.85 ng/mL) among Velo users than smokers (9% lower). Several secondary endpoints, including six BoEs (3-HPMA (246.7 ± 91.07 vs 1165.7 ± 718.35 μg/24 h), 3-OH-B[a]P (82.4 ± 217.58 vs 258.3 ± 190.20 pg/24 h), HMPMA (135.1 ± 77.85 vs 368.8 ± 183.15 μg/24 h), MHBMA (0.22 ± 0.166 vs 3.39 ± 2.943 μg/24 h), S-PMA (0.10 ± 0.059 vs 3.53 ± 2.736 µg/24 h) and total NNN (7.5 ± 24.84 vs 9.7 ± 5.93 ng/24 h)), were significantly lower among Velo users (78.8%, 68.1%, 63.4%, 93.5%, 97.2% and 22.7% lower, respectively, P < 0.0001-0.0011), while total nicotine equivalents was significantly higher among Velo users (22.6 ± 12.69 vs 12.1 ± 7.92 mg/24 h, P < 0.0001), although Velo user levels are comparable to those previously reported among oral tobacco users, and Velo user and smoker mean levels were similar in Denmark.Conclusion: As compared with smokers, exclusive users of Velo NPs have significantly less exposure to tobacco toxicants and more favourable BoPHs associated with initiating biological processes of smoking-related diseases.International Standard Registered Clinical Trial number: ISRCTN16988167.
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Affiliation(s)
- David Azzopardi
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Linsey E Haswell
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Justin Frosina
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Michael McEwan
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Nathan Gale
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | - Jesse Thissen
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
| | | | - George Hardie
- British American Tobacco (Investments) Ltd., R&D Centre, Southampton, UK
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Couch ET, Halpern-Felsher B, Werts M, Chaffee BW. Use of Emerging and Conventional Oral Tobacco Among Adolescent and Young Adult E-Cigarette Users. Subst Use Misuse 2023; 58:283-288. [PMID: 36645845 PMCID: PMC10084808 DOI: 10.1080/10826084.2022.2161314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: National surveillance assessing use of novel oral tobacco products (OTPs; nicotine pouches, lozenges, and gums not approved for tobacco cessation) among adolescents and young adults is limited. Objectives: To assess OTP behaviors in a sample of adolescent and young adult e-cigarette users, including use prevalence, dual/poly use with other products, and associated demographics. Methods: A national (United States) cross-sectional survey was conducted from March to April 2021 among 2253 participants (ages 14-20; 65% female) who ever used e-cigarettes ≥3 times. Demographics, lifetime use, and past 30-day use of 10 tobacco and cannabis products, including novel and conventional (chew, moist snuff, or snus) OTPs was assessed. Analysis was descriptive, examining use prevalence (lifetime and past 30-day) of each product, including by demographics and other product use. Results: Nearly 44% reported ever using any OTP, with nicotine pouches being the most commonly ever used (29%) and used in the past month (11%). Novel OTP use was more common among older participants (18-20 years), male participants, and past 30-day users of e-cigarettes, combustible tobacco, and conventional oral tobacco. However, female participants and combustible tobacco non-users were over twice and 4-times as likely, respectively, to use novel OTPs than conventional OTPs. Nearly 73% of past 30-day conventional OTP users were past 30-day novel OTP users. Conclusion: Novel OTP use was prevalent among adolescent and young adult e-cigarette users. Compared to conventional OTPs, novel OTPs likely have greater appeal to females and combustible tobacco non-users. Action to restrict access and reduce interest in OTPs is needed to prevent use among this population.
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Affiliation(s)
- Elizabeth T Couch
- University of California San Francisco, San Francisco, California, USA
| | - Bonnie Halpern-Felsher
- REACH Lab, Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Miranda Werts
- University of California San Francisco, San Francisco, California, USA
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Speciale Z, Rao S, Yang S, Nugent K. An Analysis of Nicotine Pouch Use by Middle School and High School Students Surveyed by the National Youth Tobacco Survey in 2021 and a Review of the Literature. J Prim Care Community Health 2023; 14:21501319231169994. [PMID: 37128171 PMCID: PMC10159243 DOI: 10.1177/21501319231169994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVES The use of alternative nicotine products by middle and high school students is a growing concern due to industry marketing techniques, availability, and popularity of new products, and ambiguous nicotine concentrations. The 2021 National Youth Tobacco Survey (NYTS) provides information about the frequency, and characteristics of middle, and high school students who have used nicotine pouches. METHODS The National Youth Tobacco Surveys provide important information about the frequency of use of tobacco and alternative nicotine products by a representative sample of students in schools in the United States. The 2021 survey included questions about the use of nicotine pouches/dissolvable tobacco products. The results from the survey were analysis using descriptive statistics, and logistic regression to model the association between the use of these alternative nicotine products, and the use of electronic cigarettes or the use of conventional cigarettes. RESULTS A total of 20 413 students participated in the survey year 2021; 17 842 were included in the final data analysis. Their ages ranged from 9 to 18+. Identified risk factors for the use of alternative nicotine products included race, and age. The adjusted odds ratio (OR) was lower in non-Hispanic Black and Hispanic students, as compared to non-Hispanic White students. Older students had a substantially higher risk of using nicotine/dissolvable tobacco products, specifically, compared to students less than or equal to 13 years old. The OR increased 174% (OR: 2.74; 1.70-4.41) in 17-year-old students. The perception of harm associated with electronic cigarettes increased the likelihood of using alternative nicotine products. Students who did not smoke cigarettes (OR: 0.39; 0.27-0.56) or did not smoke electronic cigarettes (OR: 0.20; 0.18-0.40) had significantly lower OR for using alternative nicotine products. CONCLUSIONS The 2021 National Youth Tobacco Survey indicates that a relatively small percentage of middle school and high school student have used nicotine pouches. However, with the increase in new, alternative tobacco products, understanding adolescent use in comparison to other tobacco products is an important trend to monitor.
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Affiliation(s)
| | - Sanjana Rao
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Shengping Yang
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Kenneth Nugent
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Azzopardi D, Haswell LE, Frosina J, McEwan M, Gale N, Thissen J, Meichanetzidis F, Hardie G. Biomarkers of Exposure and Potential Harm in Exclusive Users of Nicotine Pouches and Current, Former, and Never Smokers: Protocol for a Cross-sectional Clinical Study. JMIR Res Protoc 2022; 11:e39785. [PMID: 36201395 PMCID: PMC9585440 DOI: 10.2196/39785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Tobacco harm reduction (THR) aims to reduce the health burden of cigarettes by encouraging smokers to switch to using alternative tobacco or nicotine products. Nicotine pouches (NPs) are smokeless, tobacco-free, oral products that may be beneficial as part of a THR strategy. Objective This 2-center, cross-sectional confinement study conducted in Denmark and Sweden aimed to determine whether biomarkers of exposure (BoEs) to tobacco toxicants and biomarkers of potential harm (BoPHs) in exclusive users of NPs show favorable differences compared with current smokers. Methods Participants were healthy NP users (target n=100) and current, former, or never smokers (target n=40 each), as confirmed by urinary cotinine and exhaled carbon monoxide concentrations. During a 24-hour confinement period, participants were asked to use their usual product (NP or cigarette) as normal, and BoEs and BoPHs were measured in blood and 24-hour urine samples, with compliance determined using anabasine, anatabine, and N-(2-cyanoethyl)valine. BoEs and BoPHs were compared between NP users and current, former, and never smokers. Urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (BoE to nicotine-derived nitrosamine ketone) and urinary 8-epi-prostaglandin F2α type III, exhaled nitric oxide, blood carboxyhemoglobin, white blood cell count, soluble intercellular adhesion molecule-1, and high-density lipoprotein cholesterol (BoPHs) were evaluated as primary outcomes. Other measures included urinary 11-dehydrothromboxane B2, forced expiratory volume, carotid intima-media thickness, self-reported quality of life, and oral health. Results The results of this study were received in mid-2022 and will be published in late 2022 to early 2023. Conclusions The results of this study will provide information on toxicant exposure and biomarkers associated with the development of smoking-related diseases among users of NPs compared with smokers, as well as on the potential role of NPs in THR. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN16988167; https://www.isrctn.com/ISRCTN16988167 International Registered Report Identifier (IRRID) DERR1-10.2196/39785
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Affiliation(s)
- David Azzopardi
- British American Tobacco (Investments) Limited, Southampton, United Kingdom
| | | | - Justin Frosina
- British American Tobacco (Investments) Limited, Southampton, United Kingdom
| | - Michael McEwan
- British American Tobacco (Investments) Limited, Southampton, United Kingdom
| | - Nathan Gale
- British American Tobacco (Investments) Limited, Southampton, United Kingdom
| | - Jesse Thissen
- British American Tobacco (Investments) Limited, Southampton, United Kingdom
| | | | - George Hardie
- British American Tobacco (Investments) Limited, Southampton, United Kingdom
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Andersen MB, Kjeld SG, Bast LS. Changes in Cigarette Smoking and Smokeless Tobacco Use During the Coronavirus Disease 2019 Lockdown Period Among Youth and Young Adults in Denmark. Nicotine Tob Res 2022; 25:298-308. [PMID: 36000931 PMCID: PMC9452126 DOI: 10.1093/ntr/ntac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cigarettes and smokeless tobacco (snus and nicotine pouches) are prevalent among youth and young adults in Denmark. Here, we examined the extent of changes in the use of cigarettes and smokeless tobacco during the first Coronavirus Disease 2019 (COVID-19) lockdown in March and April 2020 in Denmark as well as reasons for changed behavior. AIMS AND METHODS This study used data from a nationwide survey conducted among 15- to 29-year-olds from January to March 2021 including 13 530 respondents (response rate = 36.0%). Logistic regression analyses assessed the associations between sociodemographic characteristics and the odds of initiating or increasing as well as trying to stop or decreasing cigarette smoking and smokeless tobacco use. RESULTS The prevalence of cigarette smoking was 17.8% and 10.5% reported using smokeless tobacco. Around 40% of those currently smoking cigarettes reported smoke on par during the COVID-19 lockdown as before, 24.5% started to smoke or increased their smoking, and 27.4% tried to stop or smoked less. Approximately 37% used smokeless tobacco on the same level as, before the COVID-19 lockdown, 38.8% initiated or used more, and 14.1% tried to stop or used less. Females were more prone to initiate smokeless tobacco use and increase their level of smoking during the lockdown, and younger participants smoked less. More females compared with males changed their smoking behaviors because of their mood, and more younger participants did so because of fewer social gatherings. CONCLUSION Although most youths and young adults' tobacco behaviors remained the same during the COVID-19 lockdown, many also increased or decreased their behaviors-especially females and younger participants. IMPLICATIONS This study enables the possibility of detecting new tendencies in smoking and the use of smokeless tobacco among subgroups of the population during the COVID-19 lockdown. This knowledge is crucial for identifying which groups of youths are vulnerable to increasing their tobacco use in other pandemic situations and which groups call for special attention after the lockdown period. Future efforts may focus on vulnerable groups affected by the COVID-19 pandemic, such as females, and there is a need to monitor closely whether youth tobacco use changes as society becomes more normalized.
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Affiliation(s)
- Marie Borring Andersen
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
| | - Simone G Kjeld
- Corresponding author: Simone G. Kjeld, MSc, National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark, E-mail:
| | - Lotus S Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen K, Denmark
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Bast LS, Klitgaard MB, Kjeld SG, Jarlstrup NS, Christensen AI. Use of Tobacco and Nicotine Products among Young People in Denmark-Status in Single and Dual Use. Int J Environ Res Public Health 2022; 19:5623. [PMID: 35565011 PMCID: PMC9099614 DOI: 10.3390/ijerph19095623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022]
Abstract
Lots of new tobacco or nicotine products are being launched, e.g., e-cigarettes and smokeless tobacco, which appeal especially to the youngest part of the population. For example, the use of smokeless tobacco among Danish youth rose from approx. 2% in 2010 to 9% in 2020. Hence, there is an urgent need to follow and intervene against youth tobacco or nicotine product use. This study explored the current use of cigarettes, e-cigarettes, heated tobacco, and smokeless tobacco among Danish 15- to 29-year-olds. Further, we examined the concurrent use of two products or more. We used a nationwide survey conducted among 15- to 29-year-olds in February and March 2020. Overall, approx. 35,700 individuals received the questionnaire of which 35.5% responded (n = 13,315). One out of five (20.1%) smoked cigarettes, half of them daily, the other half occasionally. About one in twenty (3.9%) used e-cigarettes (daily or occasionally), and more than one in three (31.6%) had tried e-cigarettes. The use of heated tobacco among Danish youth is still relatively limited (0.3%). In comparison, about 9% used smokeless tobacco (daily or occasionally). Overall, 27.0% stated that they use at least one type of tobacco or nicotine product, while 5.6% used more than one product. Monitoring tobacco-related behavior in youth provides extremely important information for, e.g., policymakers and health professionals.
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Affiliation(s)
- Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455 Copenhagen, Denmark; (M.B.K.); (S.G.K.); (N.S.J.); (A.I.C.)
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Tattan-Birch H, Jackson SE, Dockrell M, Brown J. Tobacco-free nicotine pouch use in Great Britain: a representative population survey 2020-2021. Nicotine Tob Res 2022; 24:1509-1512. [PMID: 35417551 PMCID: PMC9356773 DOI: 10.1093/ntr/ntac099] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Tobacco-free nicotine pouches are products that are placed between the lip and gum, where they deliver nicotine to users. Little is known about nicotine pouch use in Great Britain since they entered the market in 2019. METHODS Data came from a monthly representative survey of the adult (≥18y) population in Great Britain (England, Scotland, and Wales) between November 2020 and October 2021 (n=25,698). We estimated the weighted prevalence of pouch use, overall and stratified by demographics, smoking status, and other nicotine use. RESULTS Nicotine pouch use was rare among adults, with a weighted prevalence of just 0.26% (95% compatibility interval [CI]=0.19-0.35). Prevalence doubled from November 2020 to October 2021 (0.14% to 0.32%; Prevalence ratio [PR]=2.22, 95%CI=1.33-3.70). Pouch use was four times more common among men than women (0.42% versus 0.09%; PR=4.55, 95%CI=2.27-9.09) but less common in older age groups (p<.001). Pouch use was more prevalent among current smokers (0.87%; PR=13.60, 95%CI=5.46-33.89), recent former smokers (0.97%; PR=15.21, 95%CI=4.03-57.42), and long-term (>1y) former smokers (0.24%; PR=3.71, 95%CI=1.36-10.15), compared with never smokers (0.06%). Prevalence was also elevated among e-cigarette (1.64% versus 0.15%; PR=10.59, 95%CI=5.74-19.52) and nicotine replacement therapy users (2.02% versus 0.21%; PR=9.75, 95%CI=4.64-20.49). CONCLUSIONS One in 400 adults in Great Britain use nicotine pouches, but prevalence increased from 2020 to 2021. IMPLICATIONS Tobacco-free nicotine pouches were introduced to the market in Great Britain in 2019. We found that, while pouch use is currently rare in Great Britain, these products have become more popular over time. Pouch use is largely concentrated among younger and middle-aged men who use other nicotine products and have a history of smoking. Continued monitoring of nicotine pouch use is needed.
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Affiliation(s)
- Harry Tattan-Birch
- Department of Behavioural Science and Health, University College London, London, UK.,SPECTRUM Consortium, UK
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK.,SPECTRUM Consortium, UK
| | - Martin Dockrell
- Addictions and Inclusion, Office for Health Improvement and Disparities, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK.,SPECTRUM Consortium, UK
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