New Study Finds Flavored Nicotine Products Popular Among Teenagers

Nicotine seasoning products, which do not contain tobacco ingredients, are being sold in increasing quantities without approval from the US Food and Drug Administration. However, researchers have not investigated their use among American teenagers.

In a new study published this week in the Journal of Pediatrics, researchers from the Keck School of Medicine at the University of Southern California surveyed over 3,500 adolescents in Southern California about their use of nicotine products. Oral nicotine products ranked second, with 3.4% of teens reporting using them at least once and 1.7% reporting use within the past six months. E-cigarettes were the most popular nicotine product, with 9.6% of teens using them at least once within the past six months and 5.5% reporting use. Cigarettes, cigars, hookah, and other products were not as popular.

The primary author of the study, Alyssa F, stated, "It is surprising that these new flavored oral nicotine products are the second most commonly used product in our sample, following only e-cigarettes." Exposure to nicotine during adolescence can damage brain development, leading to learning, memory, and attention issues, as well as nicotine addiction.

Our findings are concerning because these products typically contain high nicotine levels, and we know that this is harmful to teenagers, and they can be easily hidden. Dr. Harlow also stated that they are often flavored, which can be appealing to teenagers, such as 'cherry bomb' and 'fruit mix'.

Popularity and differences.

The research team collected data in 2021 as part of the Southern California Adolescent Behavior Health Study. The participants included 3,516 ninth and tenth grade students from 11 high schools in Los Angeles, Riverside, San Bernardino, Orange and Inland Empire Counties.

Following electronic cigarettes, non-tobacco-flavored nicotine products (gum, lozenges, tablets, and gum) are the most commonly used products. Combustible tobacco products rank third, with 2% of adolescents reporting having used cigarettes, cigars, cigarillos, or hookah, and 1.3% of adolescents having used one or more of these items in the past six months. Less than 1% of adolescents have ever or in the past six months used other nicotine products such as pouches or snuff. The use of flavored nicotine oral products is more common among adolescents, who have also used other nicotine products such as cigarettes or electronic cigarettes.

Researchers have also found higher usage rates of flavored oral nicotine products among Hispanic adolescents, females, and those identified as LGBTQ.

Harlow stated, "Some of these subgroups of people are young individuals who have consistently been affected by tobacco-related disparities." "It is important that we continue to monitor the usage of these products among young people to determine the potential impact of these disparities.

Monitoring the use of nicotine.

A nationwide survey monitoring the use of nicotine among teenagers, including the Behavior Risk Factor Surveillance System by the Centers for Disease Control and Prevention and the tobacco and health population assessment by the Food and Drug Administration, has not yet been tracking new flavored oral nicotine products. Given the popularity of these products in current samples and their potential appeal to young people, it is crucial to track their popularity among teenagers and young adults, according to Harlow.

She said, "At present, we really don't know what impact it has on public health. That's why implementing national-level monitoring is the first and most important step.

While these products may cause harm to young people, they offer a potentially less harmful alternative for adults seeking to quit smoking or use electronic cigarettes. Harlow and her colleagues are studying young adult electronic cigarette use to determine how appealing new flavored nicotine oral products are compared to existing FDA-approved smoking cessation products.

They are continuing to gather data from a sample of high school students in Southern California and plan to conduct longitudinal analysis on the use of flavored oral nicotine products to determine how it may be associated with other behaviors such as e-cigarette and traditional smoking over time.

Regarding this study

In addition to Harlow, the other authors of the study include 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 from the University of Southern California's Institute for Addiction Science and Department of Population and Public Health Sciences at the Keck School of Medicine.

This work was supported by the National Cancer Institute and the FDA Center for Tobacco Products [U54CA180905], National Cancer Institute [R01CA229617], National Institute on Drug Abuse [K24DA048160; K01DA042950], and the National Heart, Lung, and Blood Institute [K01HL148907].

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