• Advertising and Promotion
• Non-cigarette tobacco products
• Tobacco industry

Tobacco control research, policy and advocacy are replete with ‘tobacco-free’ terminology. For instance, there are tobacco-free initiatives targeting removal of tobacco use, imagery and branding from major entertainment media.1 2 There are also policies promoting tobacco-free college campuses,3 parks,4 pharmacies5 and workplaces6 which help protect the environment from tobacco product litter, reduce exposure to secondhand smoke and denormalise tobacco use. The goals of these and other efforts are to create a tobacco-free generation7 and even a tobacco-free world.8

In recent years, tobacco manufacturers have begun using tobacco-free terminology to market tobacco products. Tobacco-free marketing has been used in at least two contexts. The first is to claim that the product’s nicotine source is not tobacco-derived (ie, ‘tobacco-free nicotine’, also known as synthetic nicotine). For example, in 2021, the most popular e-cigarette brand among US high school students was Puff Bar, which the manufacturer markets as being made with tobacco-free nicotine.9 10 For a short period of time, there was uncertainty with regard to how and whether products made with synthetic nicotine (eg, e-cigarettes) should be regulated. However, in April 2022, the US Food and Drug Administration (FDA) gained regulatory authority over tobacco products made with synthetic nicotine.11

The second use of tobacco-free terminology by the tobacco industry is to communicate that a nicotine-containing product is not made with tobacco leaf. For instance, such marketing is commonly used to describe nicotine pouches. First introduced into the US in 2014, nicotine pouches are made with a nicotine powder.12 13 In this way, they differ from other pouched tobacco products (eg, moist snuff, snus) which contain tobacco leaf. Despite being a new tobacco product category, sales of nicotine pouches in the US have increased considerably in recent years from $709,635 in 2016 to $216,886,819 in 2020.14 Some nicotine pouch products are made with tobacco-derived nicotine, while others claim that they are made with tobacco-free (ie, synthetic) nicotine. As a result, tobacco-free marketing may be used in both contexts to describe nicotine pouches—the product is tobacco leaf-free or the nicotine is not tobacco-derived (or both). FDA has authority to regulate nicotine pouch products as tobacco products regardless of the nicotine source and the presence or absence of tobacco leaf.

There are two important implications for the tobacco industry’s use of tobacco-free claims. First, consumers may interpret tobacco-free as a modified risk claim. Consumers are quite familiar with claims implying the absence of a harmful substance in other contexts, such as products claiming the absence of a harmful chemical (eg, BPA-free plastic) and nutritional claims communicating the absence of a harmful macronutrient (eg, sugar-free).15 Because the public perceives tobacco products as harmful, a tobacco-free claim may be interpreted as either less harm or ‘harm-free’. Indeed, one study experimentally tested the inclusion of a tobacco-free nicotine claim in an e-cigarette advertisement and found that participants viewing the tobacco-free nicotine claim had lower odds of perceiving the product to be extremely or very harmful, compared with a control advertisement with no tobacco-free nicotine claim.16 Presumably, e-cigarettes made with synthetic S-nicotine would have a similar risk profile as e-cigarettes made with tobacco-derived nicotine. This study also found that the tobacco-free nicotine claim increased product use intentions, relative to control. Thus, similar to cigarette claims, including ‘organic’, ‘natural’, ‘additive-free’ and reduced nicotine,17 18 tobacco-free claims may be misinterpreted by consumers. The Tobacco Control Act (§387 k) defines a modified risk tobacco product as ‘any tobacco product that is sold or distributed for use to reduce harm or the risk of tobacco-related disease associated with commercially marketed tobacco products’ and includes the ‘label, labeling, or advertising of which represents explicitly or implicitly that… (III) the tobacco product or its smoke does not contain or is free of a substance’. Moreover, in June of 2022, Attorneys General from 31 US states and territories sent a letter to the FDA urging the agency to deny marketing authorisation to products making tobacco-free claims ‘absent FDA authorization to make such claims under the FDCA’s modified risk tobacco product provisions’.19

Second, tobacco-free claims could create confusion among consumers. A recent survey of US young adults (ages 18–25) found that 17% of those surveyed incorrectly believed that products made with tobacco-free nicotine contained neither tobacco nor nicotine.20 This suggests that some consumers could unknowingly expose themselves to nicotine by using these products. Further, a product marketed as a ‘tobacco-free nicotine pouch’ could be especially confusing to consumers. Some may interpret this marketing to indicate a tobacco leaf-free product with unknown nicotine source, while others may interpret this to indicate a product made with synthetic nicotine. Lastly, a tobacco-free claim could also create confusion about whether tobacco control policies and regulations, such as tobacco-free school policies, would apply to these products. For instance, if a student is caught using a product marketed as tobacco-free, school administrators or parents may not realise local/state or school policies prohibit its use on school grounds.

We believe that emerging evidence suggests that tobacco-free marketing claims have the potential to confuse and mislead consumers. Article 11 of the WHO’s Framework Convention on Tobacco Control prohibits false, misleading or deceptive packaging and labelling. Many countries (including the US) have banned cigarette manufacturers from using descriptors such as ‘light’ and ‘mild’ because these terms mislead consumers. To our knowledge, no country or jurisdiction has imposed restrictions on the use of tobacco-free claims in tobacco product marketing. Additional research, including studies using experimental and longitudinal designs, is needed to understand how individuals across diverse populations interpret these marketing claims and to understand their effects on perceptions and behaviour, including initiation among young people and non-tobacco users, switching among tobacco users and dual/poly tobacco use. Other nicotine descriptors, including ‘non-tobacco’ nicotine, have been used to describe synthetic nicotine and may also be examined for consumer understanding and perceptions. To avoid the potential for inaccuracy and confusion, we suggest that researchers and advocates refrain from using the term tobacco-free to describe tobacco products. Instead, the term ‘synthetic nicotine’ may be used to describe nicotine not derived from tobacco leaf.

It is important to be aware of the potential negative consequences of using the term tobacco-free to describe tobacco products. Synthetic nicotine and tobacco leaf-free products are regulated by the FDA as tobacco products, despite sometimes being marketed as tobacco-free. Policies that restrict the use of certain terms and descriptors may be helpful to ensure that tobacco product claims are not misleading or confusing. The term tobacco-free has a long history of being used to describe policies that protect public health, including as a term to describe tobacco endgame strategies.8 The use of tobacco-free to market tobacco products has the potential to undermine these protections.