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Effects of flavour and modified risk claims on nicotine pouch perceptions and use intentions among young adults who use inhalable nicotine and tobacco products: a randomised controlled trial
  1. Erin A Vogel1,
  2. Alayna P Tackett2,
  3. Jennifer B Unger3,
  4. Maria J Gonzalez3,
  5. Natalia Peraza3,4,
  6. Nikki S Jafarzadeh3,4,
  7. Michelle K Page5,
  8. Maciej L Goniewicz5,
  9. Melissa Wong3,4,
  10. Adam M Leventhal3,4
  1. 1TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  2. 2Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  3. 3Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
  4. 4Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
  5. 5Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
  1. Correspondence to Dr Erin A Vogel, TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; erin-vogel{at}ouhsc.edu

Abstract

Background Availability of flavours and potential modified risk tobacco product (MRTP) claims may influence young adults’ (YAs’) perceptions of and intentions to use nicotine pouches (‘pouches’).

Methods YAs aged 21–34 years (N=47, Mage=24.5, SD=3.1) with past-month nicotine/tobacco use (10.6% cigarette-only, 51.1% e-cigarette-only, 38.3% dual use) and no intention to quit were randomised to self-administer four Zyn 3 mg nicotine pouches in a 4 (flavour; within-subjects: smooth, mint, menthol, citrus) × 2 (MRTP claim on packaging; between subjects: present or absent) mixed-factorial design. After self-administering each pouch, participants reported appeal, use intentions and perceived harm compared with cigarettes and e-cigarettes. Three mixed-factorial analysis of variances (ANOVAs) examined main and interactive effects of flavour and MRTP claim on appeal, use intentions and comparative harm perceptions.

Results Mint (M=55.9, SD=26.4), menthol (M=49.7, SD=26.8) and citrus (M=46.6, SD=24.8) flavours were significantly more appealing than smooth (M=37.6, SD=25.4; p<0.001). MRTP claim did not significantly affect product appeal (p=0.376). Use intentions were greater for mint (M=2.6, SD=1.3) and menthol (M=2.0, SD=1.1) flavours than smooth (M=1.8, SD=1.0; p=0.002). Flavour did not affect comparative harm perceptions (p values>0.418). MRTP claims increased use intention (p=0.032) and perceptions of pouches as less harmful than cigarettes (p=0.011), but did not affect perceived harm relative to e-cigarettes (p=0.142). Flavour × MRTP claim interactions were not significant.

Conclusions Flavoured (vs smooth) pouches were more appealing to YAs. MRTP claims reduced perceived harm of pouches compared with cigarettes; however, intentions to switch were low. To protect YAs’ health, regulatory restrictions could target flavours and MRTP claims.

  • Harm Reduction
  • Non-cigarette tobacco products
  • Packaging and Labelling

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/tc-2023-058382

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors Conceptualisation: EAV, APT, JBU, AL. Data curation: MJG, NP, NSJ. Formal analysis: EAV, MKP, MG. Funding acquisition: EAV, APT, JBU, AL. Investigation: MJG, NP, NSJ, MW. Project administration: EAV, APT, AL. Resources: MKP, MLG. Supervision: EAV, APT, AL. Writing—original draft: EAV. Writing—reviewing and editing: APT, JBU, MJG, NP, NSJ, MKP, MLG, MW, AL. Guarantor: EAV.

    • Funding This study was supported by the National Cancer Institute (U54 CA180905, P30CA14089, P30CA2255520, R01CA226917), the National Institute on Drug Abuse (K01DA055073), the National Heart, Lung and Blood Institute (K01HL148907) and the Oklahoma Tobacco Settlement Endowment Trust (R22-03). Sponsors had no involvement in study design, collection, management, analysis and interpretation of data or the decision to submit for publication.

    • Competing interests No, there are no competing interests.

    • 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.