• May 21, 2024

Show Them the Numbers

 Show Them the Numbers
By Neil McKeganey and Andrea Patton

To prevent nicotine pouches from being legislated out of the market, manufacturers must demonstrate the extent to which they are benefiting adult smokers, and quantify underage usage.

By Neil McKeganey and Andrea Patton

As tobacco companies seek to market lower harm alternatives to combustible cigarettes, there is one issue that is seriously undermining those efforts—youth use of their products. If you were in any doubt as to the scale of the threat that youth use of tobacco products represents for manufacturers, think Juul, Puff Bar, Elf Bar and disposable e-cigarettes in general. And now, critics of the tobacco industry have a new product in their sight. Fresh from their success in calling for the banning of disposable e-cigarettes, they are shifting attention to nicotine pouches with an increasingly familiar playbook of media alarm, political pronouncements and regulatory action.

The widest-selling nicotine pouch product in the U.S. is Philip Morris International’s Zyn, which grew in sales from 126 million units in 2019 to 808 million units by March 2022 (Majmundar et al. 2022). Accounting for 58 percent of the U.S. nicotine pouch market, Zyn has become a key part of PMI’s next-generation nicotine product range. It is also a product that has not had to work hard to find its critics.

Zyn is “a pouch packed with problems,” according to Senator Chuck Schumer. “These nicotine pouches seem to lock their sights on young kids—teenagers, and even lower—and then use the social media to hook them,” the senator said. Alongside Schumer’s dire warnings of a future in which young Americans are increasingly dependent on oral nicotine products, there has been a torrent of media articles casting Zyn as a major new threat to U.S. youth. In a New York Times article published at the start of the year, Emily Dreyfuss opened parents’ eyes to a world of “Zynfluencers”—social media personalities assiduously promoting oral nicotine products such as Zyn to their followers. Dreyfuss has called for age-gated advertising restrictions to limit young peoples’ exposure to “Zynfluencer” activities.

In contrast to the often hysterical tone of the media reporting on underage use of nicotine pouches, the National Youth Tobacco Survey (NYTS) estimated that in 2023, 1.5 percent of U.S. middle school and high school students had used oral nicotine pouches in the past 30 days. Likewise, the 2023 Tobacco Product Prevalence Study (TPPS) undertaken by the Centre for Substance Use Research (CSUR) in Scotland estimated that 1.7 percent of 13-year-olds to 20-year-olds in the U.S. had used a nicotine pouch in the past 30 days.

While the NYTS data relates to the category of oral nicotine pouch use, rather than Zyn in particular, the TPPS also quantifies the prevalence of underage use of Zyn and other tobacco products and devices, with 0.5 percent of 13-year-olds to 20-year-olds in the U.S. reporting past-30-day use of Zyn. Neither the NYTS nor the TPPS are detecting epidemic levels of oral nicotine pouch use among young people in the U.S. TPPS estimates show further that Zyn use is infrequent, with 70.8 percent of underage past-30-day pouch users reporting use on between one day and five days of the past 30 days.

If most U.S. Zyn sales, and subsequent use, are among those aged over 21, the possibility exists that these products may be helping adult smokers to switch from combustible to noncombustible tobacco products. Despite this, the U.S. Truth Initiative has called for a nationwide ban of Zyn.  

In the face of such calls, it will be inadequate for the industry to stress that these products are intended solely for adult smokers as an alternative to combustibles. The problem facing PMI and other oral nicotine product manufacturers is how to respond to claims of widespread use of their products by young people.

There are two things that companies must do if they are to stand any chance of keeping their products on the market. The first is to show the extent to which these products are benefiting adults who smoke. The data required here involves showing the impact of an oral nicotine product such as Zyn on an adult smoker’s ability to completely switch away from smoking or to substantially reduce their use of combustible cigarettes over a six-month to 12-month period.

Secondly, companies must quantify the extent to which their oral nicotine products are indeed being used by those below age 21. The CSUR’s Tobacco Product Prevalence Study is the only national probability-based study that collects data on a range of individual tobacco products among both adults and youth within the U.S. and provides timely estimates of use. As such, it can help manufacturers present important data to regulators on the actual extent of youth use of their products.

Unless the industry assembles the evidence with which to respond to political and media commentators’ calls to ban oral nicotine products, these companies are going to face an increasingly difficult future. The calls to ban oral nicotine products, in the absence of data showing how widely specific products and devices are being used by youth, provides an indication of just how influential a coordinated campaign against a specific product or category of products can be. It is ironic that many of those calling for such bans, no doubt motivated by a commitment to public health, find themselves advocating for legislation that will narrow rather than expand the routes out of smoking.