Public health reports celebrate a continued decline in smoking among younger generations. Does nicotine still have just as much of a hold on these generations?
Fortunately, smoking rates have declined. However, we continue to see tobacco use among high school students at an alarming rate. According to the Centers for Disease Control and Prevention (CDC), approximately 23% of high school students used some form of tobacco in 2013. In 2023, 13% of high school students used some type of tobacco, but the forms of tobacco – and nicotine – being consumed have shifted.
Could you share more on what nicotine is and how dangerous it can be? What can it do to the heart, body and brain?
There is no question that nicotine is addictive. Nicotine interacts with the nicotinic acetyl choline receptors, which stimulate dopamine transmission and the body’s reward system. Over time, chronic nicotine stimulation desensitizes the neurons and reinforces addiction by inducing cravings.
We also know that nicotine may negatively impact learning and attention span. Smoking tobacco is well known to cause numerous health issues, but nicotine is also quite dangerous. In fact, nicotine was used as an insecticide for a couple of centuries until being banned by the Environmental Protection Agency (EPA) in the U.S. in 2014.
Nicotine causes catecholamine release, which results in increased heart rate and blood pressure. On a chronic basis, this can lead to myocardial ischemia, or less oxygenation of the heart muscle, and cardiac disease. There are numerous other impacts on the body, including impaired immunologic response, increased risk of kidney disease, adverse reproductive effects in both males and females and predisposition to diabetes.
What are these pouches and why is there so much concern? What are the health risks?
The pouches contain powdered nicotine, as well as flavorings and sweeteners. The product comes in different strengths and flavors, packaged similarly to mint containers. The pouch is placed between the upper lip and gum and then dissolves. Because the product is not categorized as smokeless tobacco, it is not regulated as closely by the Food and Drug Administration (FDA).
The FDA does require a warning label that the product contains nicotine, which is known to be addictive, and limits sales to adults aged 21 and older. However, it is fairly easy to buy online. There are significant health risks, especially for a child who is nicotine-naïve who may develop acute nicotine toxicity. And, as I said before, there are significant risks associated with chronic use.
The pouches became popular partially because of their marketing on social media. How is social media influencing nicotine use in younger generations?
The product is marketed as a tobacco-free alternative with the apparent appeal of getting a nicotine fix with a discreet pouch that is easily consumed. There are influencers endorsing the pouches on social media, and there are also interesting claims of the product enhancing masculinity. One well-known news commentator stated he used the product every second he was awake.
I did a quick search of Instagram and found an incredible number of posts and memes, mostly featuring young men. It’s clear that social media is having a huge influence in this population. In a 2022 National Institutes of Health study in which videos discussing nicotine were evaluated, 28% of those videos mentioned psychological or physical benefits of nicotine, such as a “buzz.” Sales of one of the brands in the third quarter of 2023 increased just over 65% from the third quarter of 2022.
The fruit and candy flavors of these pouches and vapes have long been criticized for helping get more young people hooked on nicotine and using it more frequently. Do you think having these flavors available might influence more people to use nicotine than would be the case if there were only traditional cigarettes or tobacco flavor available?
It seems so. A clear marketing aspect of these products includes flavor options. The flavors of the pouches include not only mint and spearmint flavors, but also coffee and cinnamon. There is even a flavor quiz on the product website that results in a personalized flavor recommendation and product discount upon completion.
What are the pros and cons of ingesting nicotine in different ways, such as smoking, vaping, chewing tobacco, these pouches, gum/patches, etc.?
Certainly, smoking and vaping cause direct lung irritation, which is in addition to the harmful effects of nicotine. Carbon monoxide is also consumed with smoking, which is transferred to the blood cells, displacing oxygen. Smoking and vaping are not allowed in many public places, making those options less desirable for individuals as well.
Smokeless tobacco products generally contain tobacco-specific nitrosamines and other substances associated with cancers of the mouth, tongue, cheek and gum. Tobacco can also stain teeth and cause bad breath. The sugar content in the smokeless tobacco products can also cause tooth decay and cavities. Long-term use can also cause the gums to recede, the tooth root to become exposed, and possible tooth loss.
Is there anything you want to add?
Nicotine pouches, gum and patches may be a way in which people can quit smoking, but they are intended to be used in smaller amounts and doses as a way to wean off tobacco. There are great resources available for individuals who want to give up nicotine, such as the Colorado Quitline. This program has trained coaches available and is available at no charge.
