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Nicotine pouch marketing strategies in the USA: an analysis of Zyn, On! and Velo
  1. Zongshuan Duan1,
  2. Lisa Henriksen2,
  3. Donna Vallone3,4,
  4. Jessica M Rath3,5,
  5. W Douglas Evans1,6,
  6. Katelyn F Romm1,
  7. Christina Wysota1,
  8. Carla J Berg1,6
  1. 1 Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
  2. 2 Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
  3. 3 Truth Initiative Schroeder Institute, Washington, District of Columbia, USA
  4. 4 School of Global Public Health, New York University, New York, New York, USA
  5. 5 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  6. 6 Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
  1. Correspondence to Dr Carla J Berg, Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA; carlaberg{at}gwu.edu

Abstract

Introduction Nicotine pouches are gaining popularity, yet their marketing is understudied.

Methods Using Numerator advertising data from January 2019 to September 2021 regarding three popular brands of nicotine pouch in the USA—Zyn (by Swedish Match, introduced in the USA in July 2016), On! (Altria, August 2016) and Velo (RJ Reynolds, July 2019)—we examined (1) general advertising characteristics (eg, media type, year); (2) ad content (ie, headlines and imagery themes); (3) prominent media channels (ie, specific websites, magazines, etc); and (4) ad expenditures.

Results There were 286 unique ads (Zyn: 44.4%; On!: 2.8%; Velo: 52.8%), 119 143 occurrences (Zyn: 3.5%; On!: 0.5%; Velo: 96.0%) and $24 774 650 total expenditures (Zyn: 4.7%; On!: 0.6%; Velo: 94.7%). The greatest proportion of ad occurrences and expenditures were accounted for by radio (75.9% and 28.2%, respectively) and television (16.2% and 56.5%), followed by mobile (0.5% and 7.2%) and online display (6.7% and 3.6%). Across ad occurrences and expenditures, prominent headline themes included ‘freedom’ (26.0% and 17.1%, respectively), ‘brand’ (9.6% and 18.6%) and ‘flavour’ (16.4% and 7.6%); images mainly featured the product alone (61.4% and 56.1%), text (16.2% and 24.6%) or men (8.7% and 8.6%); and prominent channel themes were entertainment (34.7% and 37.3%), news/weather (14.3% and 21.7%), business/finance (12.9% and 9.0%) and sports (9.5% and 1.0%). Zyn and On! prioritised online display and print; Velo prioritised radio and television. Zyn’s and Velo’s headlines focused on ‘freedom’, with Zyn also emphasising ‘brand’ and Velo ‘innovation’; On!’s headlines emphasised ‘flavour’.

Conclusions Regulatory efforts must be informed by surveillance of nicotine pouch marketing and impacts on consumer subgroups (eg, young people).

  • advertising and promotion
  • harm reduction
  • non-cigarette tobacco products
  • surveillance and monitoring
  • tobacco industry

Data availability statement

Data may be obtained from a third party and are not publicly available.

https://doi.org/10.1136/tc-2022-057360

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    WHAT IS ALREADY KNOWN ON THIS TOPIC

    • In the USA, nicotine pouch sales and consumption has increased, from 163 000 units sold in 2016 to 46 million units during the first half of 2020, generally sold by Zyn, On! and Velo.

    • Historically, advertising has been fundamental to increased tobacco use uptake and maintenance.

    WHAT THIS STUDY ADDS

    • Nicotine pouches were prominently marketed on radio and television, followed by mobile and online.

    • Advertising referred to ‘freedom’ and ‘flavour’, and the most prominent media channels focused on entertainment, news/weather, business/finance and sports.

    • These findings (eg, using ‘flavour’ themes and entertainment channels) suggest some targeting of vulnerable young populations, including tobacco-naïve youth and young adults.

    HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

    • How nicotine pouches are marketed, including how and to whom they are promoted, is not well understood.

    • More specifically, little is known regarding the themes used in ads (eg, headlines, imagery) and the types of channels used to disseminate ads for nicotine pouches.

    Introduction

    Nicotine pouches, which entered the US market in 2016, are prefilled, microfibre pouches that dissolve in the mouth and contain nicotine salts (delivering high levels of nicotine1 2) in varying concentrations (up to 16 mg/g) and flavours (eg, mint, fruit).3 4 Nicotine pouch sales increased from 163 000 units ($710 000) in 2016 to 46 million units ($216 million) in January–June 2020.3 The market leader in 2020 was Zyn (by Swedish Match, 79% of unit share), followed by On! (by Altria, 10%) and Velo (by RJ Reynolds, 8%), which were introduced in the USA in July 2016, August 2016 and July 2019, respectively.3

    Ongoing surveillance of nicotine pouch marketing is needed, as marketing strategies impact how these products are perceived and used. Advertising attracts new users,5–9 promotes continued use,10–12 builds brand loyalty13 and expands tobacco markets.7 8 10 13 For newly introduced products such as nicotine pouches, advertising is fundamental to their success,14 as the first exposure is the most influential for short-term sales or gains.15 The impacts of tobacco advertising on youth and adults are widely documented,16–18 with recent research documenting the impacts of electronic cigarette (e-cigarette) marketing on harm perceptions and use intentions in youth and young adults.19 20

    Marketing campaigns are based on market research, which may segment populations based on demographic factors, behaviours, reactions to marketing messages or psychographics (eg, attitudes, needs, wants, goals, lifestyles).21–24 These strategies inform (1) how campaigns are disseminated (media type: eg, print, television, online; media channels: eg, specific magazines, websites); and (2) advertising messages used to attract consumers. In terms of marketing channels, beyond point-of-sale advertising,25 26 the tobacco industry uses traditional, new and social media, among others.27–33 Regarding advertising messages, nicotine pouches are promoted as ‘tobacco-free’ (as they contain no tobacco leaf), alternative to conventional tobacco products, cleaner (‘spit-free’, ‘smoke-free’), and discreet and convenient.2 34 35 While there is limited evidence to support some of these claims,2 36 advertising promoting such claims, as well as their various flavours, may prompt use among young people,37 38 as has been documented with regard to e-cigarette advertising.39–41

    In March 2022, the Food and Drug Administration (FDA) announced its regulatory authority over products—like Zyn, Velo and On!—that are marketed as ‘tobacco-free’, alongside a range of other products that contain synthetic nicotine (eg, e-cigarette brands like ‘Puff Bar’).42 This action was intended to ensure that synthetic nicotine and tobacco-derived nicotine products are all regulated under the same FDA standards for tobacco products.42 Manufacturers of such products are required to submit a premarket application to obtain FDA authorisation by May 2022.42 Given the increasing prominence of nicotine pouches in the USA, manufacturers of these products will likely pursue authorisation, and potentially modified risk tobacco product authorisation, which would allow the use of modified risk or exposure messaging in advertising.43

    Given this timely context, it is crucial to examine industry strategies for marketing nicotine pouches to inform regulatory efforts to protect consumers, particularly youth and young adults. Thus, this study examined advertising data regarding the three most popular brands of nicotine pouches in the USA: Zyn, On! and Velo.3 Specifically, we compared these brands in relation to (1) general advertising characteristics (ie, media type, year, market); (2) ad content (ie, themes of headlines and imagery); (3) prominent themes of media channels (eg, specific websites, magazines, etc); and (4) ad expenditures.

    Methods

    Data source

    Data for this study were purchased from Numerator, an advertising monitoring service that tracks over 2600 English-language media outlets in the USA and has been used in previous public health and tobacco-related research.44–46 Numerator systematically monitors multiple media types, including mobile, online displays/videos, print, radio, television, cinema, outdoor and social media, as well as direct mail.47

    The current study analysed mobile, online displays/videos, print, radio and television, as these were the media types used by Zyn, On! and Velo during the study period from January 2019 (when Numerator began tracking these products) to September 2021. Mobile ads are defined as ad occurrences aired on mobile devices (eg, phones, tablets), including display/banner advertising on websites and apps.47 Online display ads are those on websites in desktop/laptop environments, which are monitored using digital technology to capture daily page visits across thousands of sites.47 Online video ads reflect those ads that are aired either before or during video content (eg, pre-roll, mid-roll, etc) on websites.48 Print ads are monitored via a manual review of hard copy and digital publications within the top national newspapers and magazines sourced from multiple markets.47 Radio ads are ad occurrences that run on over-the-air radio stations. Television ads include those aired nationally during network programming (including on local broadcast affiliates or cable stations during national advertising breaks) and locally on local broadcast affiliates.48 49

    Numerator uses its defined classification system, which captures ad attributes for each creative across media types and channels, to code the advertiser, unique ad content (ie, headlines/other prominent text, visual content/imagery), if the ad was a revision of a prior/existing ad, number of occurrences of the ads (ie, ad campaigns), media type (eg, print, radio) and media channels (ie, specific websites, magazines) used for dissemination, run dates, market (eg, national or designated market area (DMA)), and cost estimates, among other variables.47 50 Ad expenditure estimates for mobile, online display and online video are derived from an industry source that aggregates expenditures for app-spend or digital web-based spend for the given run week and media value.47 Print ad expenditures are estimated based on open rates from multiple media monitoring sources (eg, Nielsen, SQAD).47 Radio ad expenditure estimates are based on station and part-of-day rates.47 Estimates for television are based on cost-per-audience information from media monitoring sources (eg, Nielsen, SQAD).47

    Data management and coding

    The sampling frame for this mixed-methods study included all data regarding advertising across brands (Zyn, On! and Velo) from January 2019 to September 2021. Variables in these analyses included media type (ie, mobile, online display, online video, print, radio, television), year (ie, run date), whether it featured unique ad content versus revised ad content and the characteristics of ad content (ie, headlines, imagery), market (ie, national, DMA), target (ie, consumers, businesses), media channel (eg, specific magazine, website, etc), and ad expenditures.

    To describe ad content, revised ads were categorised alongside the respective original ad. For each unique individual ad, each headline was recorded (see table 1 for example headlines). We also confirmed the content of images (with the data provided by Numerator). Two members of the authorship team conducted a review of all ads/headlines and developed a list of headline themes and visual themes, respectively, and then met to discuss and refine the themes. The final lists of themes were then applied to all headlines and images by the two research team members (intercoder reliability kappa=96% for headline themes and kappa=93% for visual themes); discordantly coded media channels were discussed and recoded with consensus (see table 2 for headline themes and visual themes).

    View this table:
    Table 1

    Example ad headlines across brand occurrences (n=119 143)

    View this table:
    Table 2

    Characteristics of unique ads across brands (n=286)

    Across ad occurrences, we also categorised media channel (eg, specific website, magazine, etc) by theme (eg, news/weather, travel, technology). Two members of the authorship team developed a list of themes and applied them independently to all channels (intercoder reliability kappa=89%); discordantly coded channels were discussed and recoded with consensus (see table 3 for channel themes).

    View this table:
    Table 3

    Characteristics of ad occurrences across brands (n=119 143)

    Data analysis

    Quantitative data were analysed using Stata V.15 SE and SPSS V.26.0,51 with alpha set at 0.05. Descriptive statistics were used to characterise (1) unique ads (ie, by year, ad headline themes and visual themes); (2) ad occurrences (ie, by year, media type, market, headline theme, visual theme and channel theme); and (3) ad expenditures (ie, by year, media type, market, headline theme, etc). We then conducted bivariate analyses (ie, χ2 tests for categorical variables, analysis of variance for continuous variables) to characterise differences across brands.

    Results

    Across the study timeframe (January 2019–September 2021), there were 286 unique ads (ie, unique content; 127 (44.4%) for Zyn, 8 (2.8%) for On! and 51 (17.8%) for Velo) and 119 143 ad occurrences (4117 (3.5%) for Zyn, 610 (0.5%) for On! and 114 416 (96.0%) for Velo). During this period, the total ad expenditure was $24 774 650, with $1 167 068 (4.7%) incurred by Zyn, $159 112 (0.6%) incurred by On! and $23 448 470 (94.7%) incurred by Velo.

    Ad content characteristics

    Table 1 provides the list of unique ad headlines by brand, as well as the number of occurrences they represent. For Zyn, the three ad headlines representing the most occurrences were ‘Tobacco-Free Nicotine Pouches’ (14.8%), ‘Can’t Smoke? Can’t Vape?’ (12.4%) and ‘Now You Can Enjoy Smoke-Free Nicotine Pouches’ (9.9%). For On!, the ad headline representing the most occurrences was ‘Maximum Flavor’ (73.8%), followed by ‘7 Flavors, 5 Strengths’ (16.9%). Velo’s top three ad headlines were ‘Experience Freedom’ (17.6%), ‘Anywhere’ (17.5%) and ‘We’re Ready’ (11.3%).

    Table 2 shows that, of the 286 unique ads, 80 first occurred in 2019, 92 first occurred in 2020 and 114 first occurred in 2021. Common headline themes included ‘freedom’ (eg, ‘experience freedom’, ‘now you can’, etc; 25.9%), ‘brand’ (eg, ‘America’s #1 brand’, ‘Choose [brand]’; 18.2%), ‘flavour’ (eg, ‘burst of flavor’, specific flavours promoted; 11.2%), ‘health claims’ (eg, ‘no tobacco’; 9.8%), ‘promotions’ (eg, ‘get 25% off’, ‘enter to win’; 7.0%), ‘innovation’ (eg, ‘modern way’, ‘innovatively driven’; 5.2%) and ‘convenience’ (eg, ‘hassle free’, ‘no mess’; 2.8%). The most common headline theme for Zyn was ‘freedom’ (30.9%), followed by ‘brand’ (21.3%) and ‘health claims’ (11.8%). Common headline themes for On! included ‘flavour’ (37.5%) and ‘freedom’ (37.5%). Velo’s common themes included ‘freedom’ (21.2%), ‘brand’ (16.6%) and ‘flavour’ (13.9%). The majority of ads’ visual themes featured only the product itself (49.0%) or with text (24.8%), with the product being featured with men (7.0%), women (3.1%), people/part of (eg, hands, back of person; 5.2%), men and women (6.3%), and images related to flavours (eg, ice, berries; 4.5%; table 2). For Zyn, the top visual/image themes included product (47.2%), text (29.1%) and product/male/female (10.2%); the only visual/image theme for On! was product; the most common visual/image theme for Velo was product (47.7%), followed by text (22.5%) and product/male (9.9%).

    Across all brands, the average expenditure per unique ad was $86 625, and the average expenditures per unique ad for Zyn, On! and Velo were $9190, $19 889 and $459 774, respectively. The highest expenditure per unique ad for Zyn was $219 468 on the headline ‘Find Your Zyn’; for On! $28 039 on ‘Maximum Flavor’; and for Velo $6 516 912 on ‘The Modern Take’ (table 1).

    Ad occurrence characteristics

    Displayed in table 3, the proportions of ad occurrences by year were 35.5% in 2019, 37.7% in 2020 and 26.9% in 2021 (to September). Most occurrences (75.9%) were via radio, followed by television (16.2%) and online display (6.7%). For Velo, radio (79.0%) and television (16.7%) were the most common media; occurrences were most commonly via online display for Zyn (78.0%) and On! (98.5%). Online supplemental figure 1 shows ad occurrences by brand and media type over time (ie, by quarter).

    Supplemental material

    Most ads targeted consumers (99.8% vs businesses), and 22.6% of ad occurrences were distributed nationally. On! ads were distributed only to the national market. Regarding regional markets, the greatest proportion of ad occurrences was in the Northwest region (26.8%), followed by the Southeast (20.9%), the Southwest and Mideast regions (12% respectively), and the Northeast (6.7%). Specific markets targeted (and per cent of non-national ad occurrences) were Las Vegas, Nevada (15.0%); Charlotte, North Carolina (12.3%); Atlanta, Georgia (8.8%); Houston, Texas (8.0%); Phoenix, Arizona (6.2%); Denver, Colorado (5.8%); Indianapolis, Indiana (5.6%); and Philadelphia, Pennsylvania (4.9%), collectively accounting for 66.6% of the non-national ad occurrences.

    Across mobile, online display/video and print ad occurrences, common headline themes included ‘freedom’ (26.0%), ‘health claims’ (17.4%) and ‘flavour’ (16.4%). ‘Freedom’ was the most common headline theme across ad occurrences for Zyn and Velo (38.7% and 19.0%); On!’s most common headline theme was ‘flavour’ (95.7%). The ad visual/image themes were the product itself (61.4%), followed by text (16.2%) and product/male (8.7%). On! ads only featured the product, while 30.2% of Zyn ads included text only.

    The most prominent media channel theme was entertainment (eg, People, Rolling Stone, Vibe; 34.7%), followed by news/weather (eg, CNN.com, Reader’s Digest, Weather.com; 14.3%), business/finance (eg, Fox Business, Forbes; 12.9%), sports (eg, Sports Illustrated, NFL.com, MBA.com; 9.5%), home (eg, HGTV, Home & Garden, Family Handyman; 3.8%), retail (eg, ConsumerSearch.com, eBay; 3.8%), technology (eg, Wired.com; 2.3%), women’s fashion/interest (eg, Cosmopolitan, Jezebel; 1.4%), men’s fashion/interest (eg, Maxim, Men’s Journal; 0.7%) and travel (eg, Conde Nast, TripAdvisor; 0.6%). Entertainment-focused channels were the most prominent category for On! (17.2%) and Velo (39.3%), with Zyn using retail and entertainment channels almost equally (17.0% and 16.7%).

    The average expenditure per occurrence was $207.94. The average expenditure per unique ad was highest for Zyn ($283.48), followed by On! and Velo ($260.84 and $204.94; p<0.001).

    Ad expenditures

    Table 4 highlights the ad expenditures ($24 774 650) from January 2019 to September 2021 (42.2% in 2019, 33.8% in 2020, 24.0% in 2021) across different dimensions (figure 1). A prominent proportion was spent by Velo ($23 448 470 (94.7%)), followed by Zyn ($1 167 068 (4.7%)) and On! ($159 112 (0.6%)). Overall, the majority of expenditures occurred in television (56.5%) and radio (28.2%), with significant variations by brand; Velo’s expenditures largely paralleled the overall numbers (59.5% in television and 29.8% in radio), while online display and print were prominent for Zyn (29.1% and 56.7%, respectively) and On! (65.8% and 34.2%; p<0.001). Online supplemental figure 1 shows ad expenditures by brand and media type over time (ie, by quarter).

    View this table:
    Table 4

    Ad expenditures across brands and advertising characteristics ($24.77 million total expenditures)

    Figure 1
    Figure 1

    Per cent of total ad occurrences and expenditures by brand and by quarter, 2019–2021: (A) Zyn, (B) On! and (C) Velo.

    Almost all ad expenditures (98.1%) targeted consumers rather than businesses. In addition, most expenditures (70.1%) were allocated to the national market, with the greatest proportion of the remainder allocated to the Southeast (8.8%), followed by the Northwest (8.3%), Southwest (6.6%), Northeast (3.5%) and Midwest (2.5%). The specific markets targeted (and per cent of non-national expenditures) were Houston, Texas (15.5%); Atlanta, Georgia (14.0%); Charlotte, North Carolina (12.3%); Las Vegas, Nevada (10.7%); Philadelphia, Pennsylvania (8.2%); Denver, Colorado (6.1%); Phoenix, Arizona (5.5%); and Indianapolis, Indiana (3.8%), collectively accounting for 75.7% of the non-national ad expenditures.

    Across mobile, online display, online video and print ads, expenditures were greatest for ads with headline themes focused on ‘brand’ (18.6%), followed by ‘freedom’ (17.1%), ‘innovation’ (15.8%) and ‘promotions’ (11.7%). Variations existed across brands, with ‘brand’ (54.4%) being the most prominent theme for Zyn, ‘flavour’ (65.2%) and ‘freedom’ (34.2%) for On!, and ‘innovation’ (22.4%) for Velo (p<0.001). The most prominent visual/image themes were product (56.1%) and text (24.6%). The proportions across products for visual themes were significantly different (p<0.001), with On!’s ads only featuring the product itself.

    The most prominent media channel themes in media types excluding radio and television were entertainment (37.3%), news/weather (21.7%), business/finance (9.0%) and retail (8.3%). While the largest proportions of Zyn’s and On!’s expenditures were allocated to retail channels (71.5% and 36.2%, respectively), Velo’s largest proportion of expenditures (41.2%) was allocated to channels focused on entertainment.

    Discussion

    This study is among the first to examine advertising for nicotine pouches in the USA. From January 2019 to September 2021, the three leading brands generated 286 unique ads, 119 143 ad occurrences and $24 774 650 in ad expenditures. Products were largely advertised to the national market via radio and television. Across unique ads, occurrences and ad expenditures, prominent themes included ‘freedom’, ‘brand’ and ‘flavour’, and ad images mainly featured the product alone, text or with men. Per ad occurrences and expenditures, the most prominent media channel themes (eg, magazine/website topics) were entertainment, news/weather, business/finance and sports.

    Velo accounted for ~95% of ad occurrences and expenditures during the study period, with On! accounting for a small proportion (~0.5%), which may be related to how long these products were in the US market and their market penetration. Zyn and On! both entered the market in 2016 and Velo in 2019. However, Zyn has had greater market penetration and Velo may be heavily promoted to make strides as the latecomer.3 The industry may also still be navigating its advertising strategies for these relatively new products, particularly considering their future FDA oversight.42

    Velo predominately used television and radio advertising and focused almost exclusively on consumers. Different from Velo, Zyn’s focus was print and online display and On!’s focus was online display, and both companies placed some focus on business-to-business advertising. Differential focus on consumer-targeted versus business-targeted advertising is noteworthy, as this may reflect industry efforts to influence product availability, placement, pricing and access at points-of-sale, which has been documented in studies on heated tobacco products, specifically Philip Morris’ IQOS.52–54

    The divergence in media types and adspend are related (ie, some channels are more expensive) and may reflect shifts in marketing strategies for other products, like e-cigarettes. At the early stage (2008–2013) of e-cigarette market expansion, advertising expenditure was allocated to traditional media (eg, print, radio and television),55 then moved towards social media marketing, potentially targeting youth and young adults.56 In response to the youth vaping epidemic, federal action57 included FDA sending hundreds of warning letters to e-cigarette companies using youth-oriented advertising43 and the Federal Trade Commission requiring marketing data (eg, sales, advertising) from prominent e-cigarette companies,58 among other efforts. Thereafter, major e-cigarette companies demonstrated an increasing shift in advertising from social media to traditional media channels, including television,59 and JUUL, the largest e-cigarette brand at the time, shut down its accounts on Facebook and Instagram, suspended most of its advertising activities, and withdrew flavoured (except for menthol) pods from the US market in 2018–2019.60 61 Provided this context, the differential media channels of the three nicotine pouch manufacturers may reflect different expectations of market expansion and future FDA oversight.43

    Regarding the ad content, headline themes, including ‘freedom’, ‘flavour’, ‘health claims’, ‘innovation’ and ‘convenience’, among others, are consistent with other research examining direct mail promoting oral nicotine products35 and how tobacco companies have historically promoted new products.62–64 In particular, the health claims that have been used are concerning, as there is limited evidence on the health effects of nicotine pouches relative to cigarettes. Moreover, advertising themes related to ‘freedom’, ‘innovation’ and ‘convenience’ portray nicotine pouches as an alternative to existing tobacco products, particularly in scenarios where other tobacco use is prohibited. Although most (~80%) of ad occurrences and expenditures featured the product itself or text only, a considerable proportion of visual content included men as well as women, likely to target specific gender groups,65 66 or indicators of flavours (eg, berries, ice), which may appeal to youth, young adults or novice users of tobacco products.67–69 Notably, there were differences in ad content across brands. On! ads only featured the product itself and used headlines that heavily emphasised ‘flavour’ (eg, ‘Maximum Flavor’). Velo and Zyn ads used a broader variety of imagery in their ads and used headlines focused more on ‘freedom’, with Velo also emphasising ‘innovation’ (eg, ‘The Modern Take’) and Zyn emphasising ‘brand’ (‘Find Your Zyn’). Additionally, media channels targeting entertainment and sports were also prominent in ad occurrences and expenditures, which may raise concerns that the nicotine pouch marketing may parallel the traditional tobacco products’ tactics to target vulnerable young populations groups.70 71

    Differences in geographical targeting across brands are also notable. While all of On! ads and ~90% of Zyn ads were distributed nationally, >80% of Velo ads occurred in local DMAs. The four local markets targeted most heavily (per ad occurrences and expenditures) were Las Vegas, Nevada; Charlotte, North Carolina; Atlanta, Georgia; and Houston, Texas. Notably, two of these four (Atlanta and Charlotte) were among the initial markets for Philip Morris International’s heated tobacco product, IQOS, and locations like Las Vegas and Houston show some similarities to these markets (eg, tobacco control environment, personal consumption expenditures).72

    These findings have implications for research and practice. Ongoing surveillance is needed to monitor the content, distribution channels (eg, media types, channels) and reach of nicotine pouch advertising, as well as its impact on consumers. For example, population-based research is needed to understand how target audience/consumers (particularly youth, young adults and non-users of tobacco) interpret ad content, especially headlines and images that may influence risk perceptions (eg, relative harms to cigarette, e-cigarettes and other smokeless tobacco products) and/or emphasise flavours or the discretion of product use.73 Moreover, even though nicotine pouch products have the potential to be reduced-risk products because they are not combustible and contain no tobacco leaf, further research is needed to evaluate the product constituents, exposure to toxic chemicals or biomarkers of harmful compounds.4

    Limitations

    Study limitations include the data set potentially missing ads or related meta-data, and including a relatively small number of ads. Additionally, Velo accounted for the majority of ads, occurrences and expenditures, underscoring the need to interpret overall and brand-specific strategies. Also, this study focused on explicitly paid advertising, excluding promotion via point-of-sale, social media,54 74 sponsored events or other industry strategies (eg, ‘unpaid’ articles, communication with policymakers), which warrant surveillance. Finally, societal events (eg, COVID-19) likely impacted nicotine pouch marketing during this timeframe.75 76

    Conclusions

    As the nicotine pouch market expands in the USA, surveillance of their marketing tactics and consumer impacts is needed to inform regulatory efforts. Marketing content (language, imagery) and channels used must be examined with regard to consumer perceptions of potential harms, how and why nicotine pouches should be used (eg, facilitate smoking cessation, project positive self-image), and who should use them (eg, young people, cigarette users).

    Data availability statement

    Data may be obtained from a third party and are not publicly available.

    Ethics statements

    Patient consent for publication

    Ethics approval

    This study was deemed exempt from institutional review board approval, per the George Washington University’s Institutional Review Board.

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    Footnotes

    • Twitter @RommKatelyn

    • Contributors Conceptualisation: ZD, LH, DV, JMR, WDE, KR, CW, CB. Methodology: ZD, CB. Software: ZD, CB. Validation: ZD, CB. Formal analysis: ZD, CB. Investigation: ZD, CB. Resources: CB. Data curation: ZD, CB. Writing - original draft: ZD, CB. Writing - review and editing: ZD, LH, DV, JMR, WDE, KR, CW, CB. Supervision: CB. Project administration: ZD. Funding acquisition: CB. Guarantor: CB.

    • Funding CB is supported by the US National Institutes of Health, specifically the National Cancer Institute (R01CA239178-01A1; MPIs: CB, Levine; R01CA179422-01; PI: CB; R01CA215155-01A1; PI: CB), the Fogarty International Center (1R01TW010664-01; MPIs: CB, Kegler), the National Institute of Environmental Health Sciences/Fogarty (D43ES030927-01; MPIs: CB, Marsit, Sturua), and the National Institute on Drug Abuse (R01DA054751-01A1; MPIs: CB, Cavazos-Rehg). WDE is supported by the National Cancer Institute (R01CA253013; PI: WDE). KR is supported by the National Institute on Drug Abuse (F32DA055388-01; PI: Romm).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.