Emerging Flavored Oral Nicotine Pouches

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1		Irfan Rahman	--	1205	2023-05-02 16:23:46	\|
2	Reference format revised.	Lindsay Dong	Meta information modification	1205	2023-05-03 04:40:09	\|

This entry is adapted from the peer-reviewed paper 10.3390/ijerph20054526

Oral Nicotine Pouches (ONPs) are the new form of nicotine pouches that have become a type of emerging smokeless tobacco product sold by various tobacco companies. These smokeless tobacco products are marketed for usage all over as snus containing tobacco-derived nicotine (natural) or as tobacco-free nicotine (synthetic) as substitutes for other tobacco products. Based on perception and socio-behavioral aspects, ONPs have become popular tobacco products among adolescents/young adults, and over 50% of young adult users of ONP use flavored ONPs, such as menthol/mint, tobacco, dessert/candy, and fruity, which are the most popular flavors. Various new ONP flavors are currently popular locally as well as in the online market. Tobacco, menthol, and fruit-flavored ONPs could motivate cigarette smokers to change to ONPs.

ONPs flavors toxicity

1. Introduction

Oral Nicotine Pouches (ONPs) are a type of emerging smokeless tobacco product sold by some large tobacco companies ^[1]. Originating from Scandinavia, the selling of ONPs quickly spread to many other countries, including the European Union, the United Kingdom, the United States, and Japan ^[1]^[2]^[3]. The U.S. Food and Drug Administration (FDA) closely describes these oral pouches as “ground, cut, leaf or powdered tobacco regularly available in moist or chew gum snuff often packed in a pre-portioned pouch” ^[1]^[4]. The modern ONPs differ from traditional smokeless tobacco called snus, and these newer ONPs are tobacco-free with no tobacco leaf material. Instead, they are constructed of nicotine mined from tobacco leaf and marketed in various forms, including chewable tablets, nicotine pouches, gums, and lozenges ^[5]^[6]. The appearance of these tobacco-free pouches is similar to that of snus, and similarly, the ONPs are placed in a user’s anterior maxillary vestibule (between the gum and the lip) for chemicals to be released and absorbed ^[2]^[3]. Since 2016, the U.S. ^[2]^[7] market has consisted of nicotine pouches that do not contain tobacco leaves in the final product, and since 2018, they have been in Europe ^[2]^[8]^[9].

In spite of smokeless tobacco being prohibited in some countries, a relatively higher intake of these products has been reported in Sweden and the United States ^[10], as 1800 subjects with traditional usage of snus have been reported in Sweden ^[10]. Prime components of snus pouches noted are air or sun-cured tobacco, salt, water, and food-grade flavorings ^[6], whereas the ONPs are plant-based fibers boosted by flavorings, nicotine, and other ingredients ^[11]^[12]. In ONPs, the flavors are marketed as important components, as the availability of these flavors are believed to be the reason why ONPs attracted youth and adolescents, and are used broadly ^[13].

2. Social Behavioral Aspects of Oral Nicotine Pouches

The sociological result of oral nicotine products, including vaping and pouches (smokeless products), through habitualization, commercialization, and normalization is a socially accepted illusion ^[14]. According to Berger and Luckmann (1966), a person’s sense of reality is socially constructed through human interactions, and those interactions involve repeated exposures and engagements with other habitual participants in the same or similar habit. As a result, a behavioral pattern or set of patterns becomes validated, thus starting a process called habitualization ^[15]^[16]. In a recent study, Clarke et al. (2021) stated that these products, including “e-cigarette devices and vaping fluids demonstrably contain a series of both definite and probable oncogenic responses by nicotine derivatives”. This includes benzo(a)pyrene and nitrosamines for oral, gastric, and liver effects ^[17]. Similar aspects can be attributed to flavoring compounds. However, this type of information does not usually reach public communities, especially where teenagers, adolescents, and other vulnerable populations congregate ^[18]^[19]^[20]. In fact, they use half-truths and deceiving statement—specifically, the message that harmlessness (non-toxic) of pouches/vaping exist in comparison to the effects of both cigarette/tobacco smoking ^[21]. Over a span of time, those half-truths and deliberate lies about addiction risks, as well as the physical effects of pouches/vaping and e-cigarettes, become realities among individuals and collective groups in society. Nitzkin (2014) emphasized the fact that “the tobacco-control movement is now the party deceiving the public through unfounded speculation and outright lies as to the risk posed by nicotine addictiveness to teen non-smokers (or withdrawal of nicotine polyproducts) due to perceptions behavioral effects” ^[18]^[19]^[20]^[21]. Therefore, the beginning of a socially accepted untruth became a firmly held norm. Once an untruth becomes normalized, a shared illusion develops and spreads through continued interactions containing the same or similar messages.

3. Commercialization, Perceptions, and Illusions of Nicotine Products

The commercialization of the illusion strengthens its influence through a constant buying-in, by consumers, to the false claims stated by producers and advocates of nicotine addiction through pouches and vaping. According to Boyer et al. (2020), “Vaping has been marketed as a safer alternative than smoking cigarettes, but safety data are lacking”, which can be extrapolated to ONPs ^[1]^[16]. In other words, inflated claims about the supposed innocence of nicotine influence the choices made by end users currently. As a result, demoralization occurs, in which realizations of untruths arouse moral outrage that breeds distrust among community members toward the organizations that participate in the spreading of deceptive or misleading messages about the use of these products through the deception of fruit and mint flavors ^[1]^[16]. For example, Boyer et al. (2020) emphasized the fact that “Addiction is central to the JUUL business model”. In other words, an intention to deceive candidates into becoming future nicotine users, and current ENDS users, exists and continues to influence public communities through marketing strategies and the de-emphasizing of harmful effects ^[16]. The most likely reason for the intention to deceive others in this way involves the profit motive, including the gateway to new users, by assuming that these products are not harmful.

Once an untruth becomes socially accepted and validated through positive reinforcement, the process of social normalization sets in, allowing the untruth behind the illusion to become truthful itself. At a point in time, the pattern of deception becomes embedded into the organizational culture of the companies that produce or derive benefits from advocating vape use, thus leading to further demoralization once the untruth is revealed and moral outrage erupts. Ashforth and Anand (2003) provided a pyramid that illustrated three aspects of organizational normalization ^[14].

It may be surmised, based on the aspects of this concept by Ashforth and Anand, 2003 ^[14], as projected in Figure 1.

Figure 1. Oral nicotine products and marketing leading to evading perception and policies.

(1): Commercialization is the process by which unregulated policies are enacted as a matter of routine, often without conscious thought about their propriety or based on scientific knowledge;
(2): Rationalization, or evading policies, involves the process by which individuals who engage in usage accept socially constructed accounts that artificially legitimize the acts in their own eyes and perceptions;
(3): Socialization, or behavior changes, involve the process by which newcomers are thought to perform and accept the usage as a norm or alternative to smoking.

The problems created by the socially accepted illusion of perceived harmlessness toward nicotine products deserve significant consideration in future studies on ethical responsibility, organizational functioning, leadership accountability, and health concerns for these users. Researchers in toxicology and medicine continue to intellectually fight for better delivery of all information to these consumers so that all affected by this phenomenon can make more informed decisions about nicotine products’ social and bodily impacts on individuals and societal members. The untruth behind the use of illusory advertising to influence others into nicotine product consumption requires an undoing of its framework by regulatory agencies.

References

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1. Introduction

2. Social Behavioral Aspects of Oral Nicotine Pouches

3. Commercialization, Perceptions, and Illusions of Nicotine Products

References