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Oral Nicotine Product Awareness and Use Among People Who Smoke and Vape in the U.S.

      Introduction

      Tobacco-free oral nicotine products are an emerging class of noncombustible nicotine products. Oral nicotine product sales have increased since 2016, although little research has investigated consumer awareness, use, or correlates of oral nicotine product use. The purpose of this analysis was to assess the prevalence and correlates of oral nicotine product awareness and use.

      Methods

      This paper is a cross-sectional analysis of 2,507 U.S. participants from Wave 3 (February–June 2020) of the International Tobacco Control Four Country Smoking and Vaping Survey, a population-based survey of current and former cigarette smokers and nicotine vaping product users in the U.S. Oral nicotine product awareness and use prevalence were compared with those of heated tobacco products. Analyses conducted in late 2021 assessed the correlates of oral nicotine product awareness and use such as demographic characteristics, tobacco use (cigarettes, nicotine vaping products, smokeless tobacco), and tobacco quit attempts.

      Results

      Almost 1 in 5 respondents claimed to have heard of oral nicotine products, 3.0% reported ever use, and 0.9% were current users, all of which were lower than for heated tobacco products. Ever use of oral nicotine products was more common among younger adults (e.g., aged 18–24 years), males, and current users of smokeless tobacco. Oral nicotine product prevalence was higher among those who reported having made attempts to stop smoking or vaping.

      Conclusions

      Oral nicotine product use was low among current and former smokers and nicotine vaping product users. Oral nicotine product users were demographically similar to use among individuals who smoke/vape and also use smokeless tobacco. Future studies are needed to understand emerging oral nicotine products, particularly whether they are being used as product supplements (dual use), replacements (switching), or cessation aids (quitting).
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      REFERENCES

        • Robichaud MO
        • Seidenberg AB
        • Byron MJ.
        Tobacco companies introduce ‘tobacco-free’ nicotine pouches.
        Tob Control. 2020; 29: e145-e146https://doi.org/10.1136/tobaccocontrol-2019-055321
      1. Deeming tobacco products to be subject to the federal food, drug, and cosmetic act, as amended by the family smoking prevention and tobacco control act. HHS, Food and Drug Administration. https://www.fda.gov/tobacco-products/rules-regulations-and-guidance/fdas-deeming-regulations-e-cigarettes-cigars-and-all-other-tobacco-products. Updated September 1, 2021. Accessed May 3, 2022.

      2. New law clarifies FDA authority to regulate synthetic nicotine. U.S. Food and Drug Administration. https://content.govdelivery.com/accounts/USFDA/bulletins/30f82ff. Updated March 18, 2022. Accessed April 11, 2022.

      3. Czaplicki L, Patel M, Rahman B, Yoon S, Schillo B, Rose SW. Oral nicotine marketing claims in direct-mail advertising. Tob Control. In press, Online, 6, May, 2021. https://doi.org/10.1136/tobaccocontrol-2020-056446.

        • Lunell E
        • Fagerström K
        • Hughes J
        • Pendrill R.
        Pharmacokinetic comparison of a novel non-tobacco-based nicotine pouch (ZYN) with conventional, tobacco-based Swedish snus and American moist snuff.
        Nicotine Tob Res. 2020; 22: 1757-1763https://doi.org/10.1093/ntr/ntaa068
        • Liu J
        • Wang J
        • Vansickel A
        • Edmiston J
        • Graff D
        • Sarkar M.
        Characterization of the abuse potential in adult smokers of a novel oral tobacco product relative to combustible cigarettes and nicotine polacrilex gum.
        Clin Pharmacol Drug Dev. 2021; 10: 241-250https://doi.org/10.1002/cpdd.909
        • Rensch J
        • Liu J
        • Wang J
        • Vansickel A
        • Edmiston J
        • Sarkar M.
        Nicotine pharmacokinetics and subjective response among adult smokers using different flavors on!® nicotine pouches compared to combustible cigarettes.
        Psychopharmacology (Berl). 2021; 238: 3325-3334https://doi.org/10.1007/s00213-021-05948-y
        • McEwan M
        • Azzopardi D
        • Gale N
        • et al.
        A randomised study to investigate the nicotine pharmacokinetics of oral nicotine pouches and a combustible cigarette.
        Eur J Drug Metab Pharmacokinet. 2022; 47: 211-221https://doi.org/10.1007/s13318-021-00742-9
        • Azzopardi D
        • Liu C
        • Murphy J.
        Chemical characterization of tobacco-free “modern” oral nicotine pouches and their position on the toxicant and risk continuums.
        Drug Chem Toxicol. 2021; (In press. Online May 25)https://doi.org/10.1080/01480545.2021.1925691
        • Delnevo CD
        • Hrywna M
        • Miller Lo EJ
        • Wackowski OA
        Examining market trends in smokeless tobacco sales in the United States: 2011-2019.
        Nicotine Tob Res. 2021; 23: 1420-1424https://doi.org/10.1093/ntr/ntaa239
        • Marynak KL
        • Wang X
        • Borowiecki M
        • et al.
        Nicotine pouch unit sales in the U.S., 2016-2020.
        JAMA. 2021; 326: 566-568https://doi.org/10.1001/jama.2021.10366
        • Li L
        • Borland R
        • Cummings KM
        • et al.
        Patterns of non-cigarette tobacco and nicotine use among current cigarette smokers and recent quitters: findings from the 2020 ITC Four Country Smoking and Vaping Survey.
        Nicotine Tob Res. 2021; 23: 1611-1616https://doi.org/10.1093/ntr/ntab040
        • Brose LS
        • McDermott MS
        • McNeill A.
        Heated tobacco products and nicotine pouches: a survey of people with experience of smoking and/or vaping in the UK.
        Int J Environ Res Public Health. 2021; 18: 8852https://doi.org/10.3390/ijerph18168852
        • Plurphanswat N
        • Hughes JR
        • Fagerström K
        • Rodu B.
        Initial information on a novel nicotine product.
        Am J Addict. 2020; 29: 279-286https://doi.org/10.1111/ajad.13020
      4. ITC Project. (2021, July). ITC Four Country Smoking and Vaping Survey, Wave 3 (4CV3, 2020) Technical Report. University of Waterloo, Waterloo, Ontario, Canada; Medical University of South Carolina, Charleston, South Carolina, United States; Cancer Council Victoria, Melbourne, Australia; the University of Queensland, Australia; King’s College London, London, United Kingdom; 2020 (4CV3; 2020) [Preliminary Technical Report].

        • Fong GT
        • Cummings KM
        • Borland R
        • et al.
        The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project.
        Tob Control. 2006; 15: iii3-iii11https://doi.org/10.1136/tc.2005.015438
        • Thompson ME
        • Fong GT
        • Boudreau C
        • et al.
        Methods of the ITC Four Country Smoking and Vaping Surveysurvey, Wave 1 (2016).
        Addiction. 2019; 114: 6-14https://doi.org/10.1111/add.14528
      5. Hrywna M, Gonsalves NJ, Delnevo CD, Wackowski OA. Nicotine pouch product awareness, interest and ever use among U.S. adults who smoke, 2021. Tob Control. In press. Online February 25, 2022. https://doi.org/10.1136/tobaccocontrol-2021-057156.

        • Havermans A
        • Pennings JLA
        • Hegger I
        • et al.
        Awareness, use and perceptions of cigarillos, heated tobacco products and nicotine pouches: a survey among Dutch adolescents and adults.
        Drug Alcohol Depend. 2021; 229109136https://doi.org/10.1016/j.drugalcdep.2021.109136
        • Cornelius ME
        • Wang TW
        • Jamal A
        • Loretan CG
        • Neff LJ.
        Tobacco product use among adults - United States, 2019.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 1736-1742https://doi.org/10.15585/mmwr.mm6946a4
        • Cheng YC
        • Rostron BL
        • Day HR
        • et al.
        Patterns of use of smokeless tobacco in U.S. adults, 2013–2014.
        Am J Public Health. 2017; 107: 1508-1514https://doi.org/10.2105/AJPH.2017.303921
        • Borland R
        • Cooper J
        • McNeill A
        • O'Connor R
        • Cummings KM
        Trends in beliefs about the harmfulness and use of stop-smoking medications and smokeless tobacco products among cigarettes smokers: findings from the ITC four-country survey.
        Harm Reduct J. 2011; 8: 21https://doi.org/10.1186/1477-7517-8-21
        • O'Connor RJ
        • Hyland A
        • Giovino GA
        • Fong GT
        • Cummings KM.
        Smoker awareness of and beliefs about supposedly less-harmful tobacco products.
        Am J Prev Med. 2005; 29: 85-90https://doi.org/10.1016/j.amepre.2005.04.013
        • Stanton CA
        • Sharma E
        • Edwards KC
        • et al.
        Longitudinal transitions of exclusive and polytobacco electronic nicotine delivery systems (ENDS) use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016).
        Tob Control. 2020; 29: s147-s154https://doi.org/10.1136/tobaccocontrol-2019-055574
        • Hatsukami DK
        • Severson H
        • Anderson A
        • et al.
        Randomised clinical trial of snus versus medicinal nicotine among smokers interested in product switching.
        Tob Control. 2016; 25: 267-274https://doi.org/10.1136/tobaccocontrol-2014-052080
        • Biener L
        • Roman AM
        • Mc Inerney SA
        • et al.
        Snus use and rejection in the USA.
        Tob Control. 2016; 25: 386-392https://doi.org/10.1136/tobaccocontrol-2013-051342
        • Burris JL
        • Wahlquist AE
        • Alberg AJ
        • et al.
        A longitudinal, naturalistic study of U.S. smokers’ trial and adoption of snus.
        Addict Behav. 2016; 63: 82-88https://doi.org/10.1016/j.addbeh.2016.07.008
        • Carpenter MJ
        • Wahlquist AE
        • Burris JL
        • et al.
        Snus undermines quit attempts but not abstinence: a randomised clinical trial among U.S. smokers.
        Tob Control. 2017; 26: 202-209https://doi.org/10.1136/tobaccocontrol-2015-052783
        • Regan AK
        • Dube SR
        • Arrazola R.
        Smokeless and flavored tobacco products in the U.S.: 2009 Styles survey results.
        Am J Prev Med. 2012; 42: 29-36https://doi.org/10.1016/j.amepre.2011.08.019