American Cancer Society, Which De-Listed Smokeless Tobacco as a Cancer Risk, Now Targets Nicotine Pouches

 

The journal JAMA Network Open last month published a short report by American Cancer Society and University of Georgia researchers who used Nielsen retail scanner point-of-purchase sales data to estimate U.S. sales of four nicotine pouch brands: Zyn, Rogue, On! and Velo.  While the authors acknowledged that their “data did not represent all nicotine pouch products and online sales,” they still reported a whopping increase in consumption: “Overall sales [of nicotine pouches] increased from 126.06 million units from August to December 2019 to 808.14 million units from January to March 2022.”

This raised a red flag at the American Cancer Society, which issued a press release subtitled, “Researchers at the American Cancer Society stress health interventions to continue reducing nicotine pouch use.”  What health concerns did they cite?  The press release mentions “flavorings, sweeteners”, “colorful packaging that looks like mint containers,” and the usual culprit, “addictive chemical nicotine, which can negatively impact your learning, attention span, and proneness to addiction.”

The closing line of the report reflects the real intent of the authors and the Society: “Health campaigns warning of potential adverse health outcomes of nicotine pouches are needed.”

The question remains: What are those “adverse health outcomes”?  Four years ago, the Society issued a policy paper identifying the top 17 causes of cancer (here).  Smokeless tobacco products were not on the list, as the Society promised to “focus on the primary goal of ending deadly combustible tobacco use.”

Today, the Society has apparently shifted its focus to nicotine pouches.

The American Cancer Society has for decades opposed all nicotine/tobacco products.  Since smokeless products are vastly safer quit-smoking options, the organization has betrayed its “vision to end cancer as we know it for everyone.”  Rather than ensuring “that everyone has an opportunity to prevent…cancer,” the Society ensures that smokers and their families continue to suffer. 

Seven years ago I wrote, “It is time for tobacco users, their families and friends to send a message to the American Cancer Society: ‘Say goodbye to our donations.’  Tell ACS volunteers in your community that the society must acknowledge scientific facts and abandon its tobacco prohibition stance.  Until the ACS tells the truth about tobacco harm reduction, charitable contributions should be directed elsewhere.”

First Study of ZYN, A Novel Consumer Nicotine Product

The American Journal on Addictions has just published (here) an analysis by my colleagues and me of the consumer appeal of a new nicotine product, ZYN.

Swedish Match test-marketed ZYN six years ago in Colorado; distribution expanded to 11 states in the western U.S. in 2016, and nationwide in April 2019.  While ZYN marketing was limited to a website and point-of-sale promotions, press reports (here, here and here) indicated remarkable sales success. 

In 2018, the company commissioned from a private contractor two marketing surveys on ZYN perceptions and use.  Last year a research group consisting of Drs. Karl Fagerström from Sweden and John Hughes from the University of Vermont, as well as Nantaporn Plurphanswat and me from the University of Louisville, was granted full access by Swedish Match to that survey data so that we could produce an independent analysis.  Our group previously published a research article describing how proposed changes in Swedish snus warning labels would affect tobacco users’ perceptions and use of the products (here).  Other than providing us with the data, the company had no role in our analysis or reporting of the results.       

In the current study, we assess adult appeal and interest in buying ZYN, and we describe the characteristics of ZYN users and patterns of ZYN use after purchase.

We found that while nearly 90% of never and former tobacco users did not find ZYN to be appealing, one-third of current smokers, more than half of current smokeless tobacco (ST) users, and two-thirds of dual cigarette-ST users did.  More importantly, only 3% of never, and 2% of former users were interested in buying the product.

In addition, we found that the likelihood of buying ZYN compared with other tobacco products was highest among exclusive ST users.  That cohort may be more inclined to buy ZYN because its manner of use is similar to that of other ST products, i.e., placing the product between the lip and gum; additionally, Swedish Match was offering the product on stores’ ST shelves.

The vast majority of ZYN users were white men, which is consistent with ST use. About 90% used the pouches every day, and most chose the 6 mg nicotine pouch, rather than the 3 mg version.  More than one-third had used ZYN about 3-6 months.

When offered a variety of reasons for using ZYN, participants frequently chose options such as “less harmful…”, “no one can tell when using”, and “to avoid spitting”.  Among current smokers, the top answers were, “less harmful for my health than cigarettes” and “do not cause me to smell like smoke/tobacco.”

There was no information about tobacco cessation due to ZYN, and time since quitting tobacco, so we cannot know if participants used ZYN to quit other products.  We also had no information about how frequently and how many pouches were used.

ZYN’s striking entry was quickly followed by similar products DRYFT (https://getdryft.com) and On! (www.onnicotine.com ).  None of these brands contain tobacco, only pharmaceutical-grade nicotine at different levels: ZYN pouches contain either 3 or 6 mg; On! is available in 2, 4 and 8 mg strengths; and DRYFT pouches have 2 or 7 mg. The highest nicotine dose approved by the FDA for medicinal nicotine gum and lozenges is 4 mg. Higher nicotine doses in the new pouch products may explain their popularity, since medicinal nicotine offerings have proven unsatisfying to consumers who can’t or don’t want to achieve nicotine abstinence.

Our study was the first to assess interest in and actual usage of a new tobacco product, ZYN nicotine pouches.  Non-users of tobacco had little interest, and ST users constituted the majority of ZYN regular users.

 

 

 

Smokers: Step Away From the Fire With These Safer Cigarette Substitutes

Most cigarette smokers “say” they want to quit, but that is terribly misleading.  Most smokers answer yes to the quitting question because they know it’s the desired response.  In reality, the vast majority of smokers don’t quit in any given year.  All of them would welcome a healthier lifestyle, but they are unable or unwilling to abandon the immediate benefits of tobacco and nicotine, especially smoking.

If you smoke, here’s your guide to vastly safer substitutes that provide nicotine and tobacco satisfaction.

E-Cigarettes and Vape Products

The best harm reduction options for smokers unable or unwilling to give up nicotine and tobacco are e-cigarettes and vape products.  There are thousands of choices, reflecting the fact that they are the most popular – and most successful – quit-smoking aids. 

Vape Shops

Smokers can take the first step away from the fire by visiting local vape shops, which are often staffed by former smokers who are knowledgeable about your best options and dedicated to your success.  These shops sell popular products and also cater to vapers who want advanced hardware and special e-liquid flavors.  To locate nearby shops, check out Vaping 360’s online locator.  The Vapetrotter Directory is another valuable source.

For lots of factual information about e-cigarettes and vape products, visit the website operated by Consumer Advocates for Smoke Free Alternatives Association.  And for moral support, visit CASAA’s testimonials webpage containing thousands of success stories.

 

JUUL

JUUL has taken the vaping market by storm; it’s making cigarette manufacturers nervous, and for good reason.  JUUL pods contain a satisfying nicotine salt that won’t have you climbing the walls or kicking the dog because you don’t have the nicotine hit you need.  Additionally, the pods are inconspicuous, and easy to use and recharge. 

JUUL products are widely available, although the company is only selling tobacco and menthol flavors in convenience and other brick and mortar stores. Its popular flavors -- mango, cucumber, fruit, and crème – are available online.

Vuse

Vuse is another family of vaping products that are available in several hardware choices and a wide variety of flavors, including menthol, mint, mixed berry, melon, fruit-and-cream, chai, nectar, tropical fruit and classic tobacco. 

Vuse is available online and in stores nationwide.

Heat-Not-Burn Products

IQOS

The FDA recently approved the sale of IQOS heat-not-burn products in the U.S.  They are already available in over 30 other countries, and they have produced an unprecedented decline in cigarette consumption in Japan.  An FDA advisory committee in 2018 concluded that the products significantly reduce smokers’ exposure to toxic chemicals found in cigarette smoke.  I believe IQOS products have the potential to compete with vapor products, as they deliver the tobacco flavor and satisfaction many smokers find lacking in e-cigarettes. 

The first U.S. test market for IQOS will be Atlanta, where it will be available at a dedicated Lenox Square store. 

Nicotine Pouches

            ZYN

ZYN is a discrete new pouch product from Sweden that contains no tobacco, just nicotine and flavor – spearmint, wintergreen, cool mint, coffee, cinnamon or peppermint.  Also note that there are two strengths, ZYN 3 and ZYN 6 (milligrams). 

Originally launched in Western states, ZYN is now available nationwide anywhere cigarettes are sold.  It’s also available from Northerner.com. 

On!

On! is another nicotine pouch made in Sweden, available in mint, wintergreen, cinnamon, berry, citrus and coffee flavors and in three strengths, 2, 4 and 8 milligrams.

These pouches have been in limited distribution here in the U.S., and they are also available at Northerner.com.  However, Altria has just bought a large share of the company, so look for these pouches soon in your local convenience store.

Smokeless Tobacco

Camel Snus

Camel Snus packets come in several flavors: mint, frost (spearmint) and winterchill (wintergreen).  If you prefer more tobacco flavor, try Robust or Mellow.  There are also two sizes, a slim version containing 0.6 gram of tobacco, and a larger pouch with 1.0 gram.  I suggest that smokers start with the small size of their favorite flavor.

Camel snus is available nationwide anywhere cigarettes are sold, and online at Northerner.com. 

Skoal Snus

Skoal Snus packets come in mint and smooth mint. 

You can find them nationwide in the smokeless tobacco section of convenience stores, and they are available at Northerner.com.

Skoal Bandits

In 1995, when conducting the first-ever smoking cessation clinical trial using smokeless tobacco (abstract here), my research group recommended that smokers switch to Skoal Bandits, the only widely available pouched smokeless tobacco product at that time.  They are still available nationwide in wintergreen and mint flavors.

Oliver Twist

Oliver Twist is the planet’s most discrete smokeless tobacco product.  It consists of mini-rolls of tobacco (smaller than a pencil eraser), which are made in Denmark by rolling whole tobacco leaves into a rope, which is then cut into small pieces.  Flavors include original (tobacco), wintergreen, sunberry and tropical.

Oliver Twist can be difficult to find.  Look for stores that sell premium cigars and pipe tobacco, or order it at Northerner.com.      

Helpful Tips:

First and foremost, place smokeless products inside your UPPER LIP.  That is the key to minimize tobacco juice and the need to spit.  At first it might feel like a cannonball, but it won't be noticeable.

There are many options, so don’t be discouraged if one product doesn’t fit your lifestyle or taste.

Whatever product you use, get your nicotine buzz, but don’t overdo it. When you inhale cigarette smoke, you get an immediate nicotine kick, and during your smoking career you learned to optimize your buzz. The effect from e-cigarettes or smokeless tobacco may be different, but you’ll learn how to get a similar effect.

Stick to the switch. Although some smokers make the transition quickly, smoke-free tobacco products don’t automatically “cure” your desire for another cigarette. These products will make it easier to quit and they’ll make those cravings less intense, but they don’t entirely replace the smoking ritual. If you’ve smoked for years, breaking the habit can still be a challenge.

If your ultimate goal is complete nicotine and tobacco abstinence, stepping away from the fire is a critical first step.  Remember that it’s the smoke that kills, so becoming and staying smoke-free, not necessarily nicotine- or tobacco-free, is your first priority.  It’s the key to a longer and healthier life.