Trends in use and regulation of novel tobacco and nicotine products in the United States

In the US, use of electronic nicotine delivery devices (“e-cigarettes”) is concentrated in adolescents and young adults. Data show prevalence of use decreasing steadily with increasing age after age 21. Thus, it is especially important to study use of novel nicotine delivery products in young people. While e-cigarette use rose rapidly among high school students after 2010, recent survey data suggests a drop since 2019. As of 2022, 16.5% of high school students report current tobacco use, and e-cigarettes are the most commonly used product. E-cigarette use is also associated with lower academic achievement and psychological distress. Surveys of US youth indicate that e-cigarettes are associated with fewer negative characte­ristics compared with conventional cigarettes. More than 8 out of 10 current e-cigarette users (87.6%) used flavored e-cigarettes, with fruit flavors being the most popular, followed by candy, desserts, or other sweets; mint; and menthol. Novel tobacco and nicotine products are no longer niche products, as major cigarette manufacturers now also manufacture and market e-cigarettes and other pro­ducts. Most recently, nicotine pouches, also appearing in flavors appealing to youth, are rapidly rising in popularity. These products are marketed through social media, where it can be difficult to distinguish between commercial marketing messages and user generated content. The US FDA recently issued warning letters to retailers over underage sale of nicotine pouches. And public health organizations have called on the FDA for stronger regulation of nicotine pouches. Given the ongoing use of novel nicotine and tobacco products among youth, there have been efforts to develop counter marketing campaigns and cessation aids for youth to quit vaping. These include the Truth Initiative’s “Breath of Stress Air” campaign and quit vaping content on Smokefree.gov. Continued monitoring and attention to the evolving tobacco product marketplace and it’s impact on youth tobacco use is needed to control the use of these products and their potential long term effects on patterns of tobacco use.

DISCLOSURE

The author reports no conflict of interest.

Mark Parascandola is Director of the Research and Training Branch in the Center for Global Health at the NCI. He has authored over 75 published articles on global cancer prevention, implementation science, and tobacco control. Dr. Parascandola served as an Embassy Science Fellow and advisor on tobacco control and air pollution at the U.S. Embassies in Beijing and Warsaw.