Article Text
PDF
Abstract
Significance Nicotine-containing products, labelled as being ‘tobacco-free’ nicotine (TFN), are marketed to consumers as alternatives to conventional tobacco products. Little is known about these emerging products and their contents.
Methods Moisture, total nicotine and pH content were analysed in 70 commercially available TFN products, covering five different types (lozenges, chewing gum, loose leaf, toothpicks and pouches). The freebase nicotine was calculated using the measured pH values.
Results Total nicotine levels ranged from 0.822 to 31.5 mg/g. Nicotine levels were highest in nicotine pouches (1.41–8.11 mg/product) and lowest in toothpicks (1.19–1.57 mg/product). Nicotine levels in TFN loose leaf (1.26–9.16 mg/g) were comparable to conventional moist snuff. The pH ranged from pH 4.68 to 9.49 and per cent freebase nicotine ranged from 0.0453% to 96.7%. The freebase nicotine content was highest in nicotine pouches (2.15–16.8 mg/g) and lowest in lozenges (0.0004–0.349 mg/g). The majority of TFN products (91.4%) analysed were advertised to contain flavour components.
Conclusion Overall, products advertised as higher strength were found to have higher nicotine content than products advertised as lower strength. The measured total nicotine content was either equal to or less than the level stated on the label, except for one product. Although TFN products may not contain tobacco lamina and may lack many harmful chemicals and carcinogens found in conventional smokeless products, freebase nicotine levels in the pouch products are elevated and could contribute to higher levels of addiction and other negative health effects.
- Addiction
- Cessation
- Nicotine
- Non-cigarette tobacco products
- Tobacco industry
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
WHAT IS ALREADY KNOWN ON THIS TOPIC
More ‘tobacco-free’ nicotine products are emerging in the market with a variety of flavours. These product types presently have the fastest growth in sales.
WHAT THIS STUDY ADDS
The study broadens the scope of additional types of ‘tobacco-free’ nicotine (TFN) products (lozenges, chewing gum, loose leaf and toothpicks), alongside nicotine pouches.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
The chemical and physical property characterisations of TFN products can help inform public health professionals, consumers and regulatory authorities about product content and the products’ potential impact on public health.
Introduction
Global policies and educational campaigns have successfully reduced tobacco prevalence throughout the world.1–4 Recently, new oral nicotine products, such as pouches, gum, lozenges, toothpicks and loose leaf products, that are labelled or marketed as being ‘tobacco-free’ nicotine (TFN) have emerged onto the market.5 6 These products are distinct from nicotine replacement therapy (NRT) medications, which are Food and Drug Administration (FDA)-approved for smoking cessations, and are also available in the form of gum and lozenge. The products in this study claim to contain nicotine extracted from tobacco plants or synthetically derived nicotine and do not contain tobacco lamina. Thus, the delivery of certain harmful constituents, such as tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, volatile organic compounds, metals and numerous other harmful agents may be reduced or eliminated.7–9 While nicotine itself is not classified as a carcinogen, it is highly addictive and drives tobacco product use which, in turn, causes tobacco-related disease and death.1 Freebase nicotine is quickly absorbed through oral membranes, giving users an instant hit.10 Higher pH levels increase freebase nicotine content in the oral product, which enhances absorption and promotes nicotine dependency.10 11 Nicotine is additionally linked to adverse cardiopulmonary effects, potential harm to brain development in individuals up to about age 25, and risks to fetal and postnatal development.1 12–15 Acute nicotine exposure can be toxic and ingestion of nicotine by young children can be harmful.13 14 16 17 The resemblance of certain TFN products to commonly orally consumed items with flavourings, such as chewing gum, breath mints and throat lozenges, raises concerns about the heightened risk of intentional or unintentional ingestion among children.16 17
Since the introduction of TFN products onto the market in 2016, sales have experienced a significant increase.18 19 The 2022 Smokeless Tobacco Report by the US Federal Trade Commission revealed that nicotine pouches, pucks and lozenges labelled ‘tobacco free’ had sales worth approximately $1.06 billion in the USA, more than double the amount from 2020.19 One manufacturer’s nicotine pouches alone are available in nearly two dozen markets worldwide.20 This suggests a trend towards TFN products and their growing importance in the tobacco industry. The US FDA has regulatory authority over products containing tobacco and nicotine from sources other than tobacco.21 However, there are no FDA regulations defining standards for the ingredients used in TFN products. TFN products are available in a variety of flavours, ranging from mint and spearmint to fruity and candy-like flavours, likely appealing to new and younger users.22 Data from the 2023 National Youth Tobacco Survey reveals that approximately 800 000 US middle and high school students reported using oral nicotine products (defined as lozenges, discs, tablets, gums, dissolvable tobacco products and other products) at least once in their life, and approximately 310 000 students reported using these products within the past 30 days.23 In addition, approximately 580 000 students reported ever using nicotine pouches, and approximately 400 000 reported using these products within the past 30 days.23 The increasing market presence of flavoured TFN products serves as an indicator of the appeal among consumers.6 18
Previous research conducted in our laboratory focused on analysing nicotine pouches, specifically.24 The present study outlined here broadens this scope by encompassing additional types of TFN products (lozenges, chewing gum, loose leaf and toothpicks), alongside various brands of nicotine pouches. This study offers a comprehensive analysis of 70 novel TFN products from different brands, nicotine strengths, flavour choices and delivery methods, covering parameters such as per cent moisture content, product weight, total nicotine content, pH and unprotonated (freebase) nicotine content. These findings provide valuable insights for public health professionals, consumers and potential regulatory bodies regarding the composition of these products and their potential implications for public health.
Methods
We procured 70 distinct nicotine products from six manufacturers (R.J. Reynolds Vapor Company, Altria Group, Deer Dip, Fully Loaded, Pixotine Products and Rogue Holdings) at various locations across the metropolitan Atlanta area in 2020, sourced from Lab Depot (Lab Depot, 469 Lumpkin Campground Rd. S Dawsonville GA 30534). The products were chosen based on popularity and variety of strengths. The products were stored in original containers at −80°C and were equilibrated to room temperature prior to analysis. Product masses were determined using a Mettler Toledo analytical balance (Mettler XP205DR; Columbus, OH, USA). The moisture content, pH and nicotine levels of the products were assessed in triplicate, with replicates obtained from different containers of the same product.
Measurement of moisture
Moisture content was measured in nicotine pouches and loose leaf products using a previously reported method.25 26 A Mettler Toledo analytical balance (Mettler XP205DR; Columbus, OH, USA) was used to measure product contents to the nearest +0.00001 g. Approximately 1.5 g of each product was weighed into a foil weighing pan, dried at 99°C for 3 hours, cooled in a desiccator and weighed for the final weight. The percentage moisture content (% moisture) is calculated as the difference between final mass (dry weight) and the original mass (wet weight).
Measurement of pH
pH measurements were made using an automated pH metre (ManSci; Orlando, Florida, USA). Approximately 1 g samples were combined with a 10 mL aliquot of distilled, deionised water in a vial. Following a 30 min mixing period, the samples were left in darkness for 1 hour. The supernatant was then decanted into a prelabelled sample vial, and after a 5 min equilibration period, pH measurements were performed in accordance with the ISO 17025 validated method.25 26
Measurement of nicotine
Total nicotine concentrations were measured using a gas chromatography-mass spectrometry method in selected ion monitoring mode (SIM), previously described, with slight modifications to the extraction process.25 27 Lozenges, chewing gum and toothpicks were cut using a scissor into pieces as necessary. Loose leaf was small enough to be weighed without cutting. For pouch products, the pouch material (organic cellulose compounds that create a non-woven fleece) was cut open and the nicotine binder/filler was weighed. After 0.4 g of products were weighed, 1 mL of 2N NaOH was added, vortexed and allowed to stand for 15 min. A 10 mL aliquot of MTBE extraction solution (containing quinoline internal standard) was added, and the sample extracts were shaken for 1 hour. A 1 µL injection was analysed by an Agilent 7890 GC coupled with a 5975 MSD (Agilent Technologies; Newark, DE, USA) using SIM. Freebase nicotine was calculated, as done previously by Stanfill et al, by substituting the pKa value for nicotine, 8.02 at room temperature (25°C), and the measured pH value into the Henderson-Hasselbalch equation and multiplying by 100.25 27
Data analysis
Moisture (per cent), pH and total nicotine (mg/g) were compared among the product types, brands and labelled strengths. Calculations of nicotine per product (mg/product) were calculated by dividing the nicotine (mg/g) by the weight of product. All statistical analysis was performed using JMP V.16.0.0 and SAS V.9.4 (SAS Institute, Cary, NC) to calculate means and SEs for sample weight, moisture, pH and nicotine (total and freebase) by product. Mixed effects models were used to compare different product types to account for repeated measurements and tobacco product types as fixed effects. The least squares means and pairwise comparisons were performed for the tobacco product types and Bonferroni correction was used to adjust the p values for multiple comparisons. Differences were considered statistically significant when p value ≤0.05. If p values were not indicated, p<0.0001.
Results
70 TFN products were categorised into five distinct types: lozenges (31%), chewing gum (9.0%), loose leaf (24%), toothpicks (4%) and pouches (33%). Mean values and SEs for variables including per cent moisture, total nicotine content, pH, as well as calculated percentages of freebase nicotine and nicotine concentration (total and freebase) for product types, brands and strength, are presented in table 1, with a complete list of products in online supplemental table 1. Most products, 64 out of 70, had flavour descriptors (fruit, crema, citrus, cherry, mint, etc) with the remaining six considered as tobacco-flavoured products (the classic, original and straight flavour).28
Supplemental material
Summary of Means (SE) of per cent moisture, total nicotine, pH and calculated per cent freebase nicotine and calculated nicotine (total, freebase) in products analysed in this study
The moisture ranged from 45.0% to 56.1% for loose leaf and from 1.91 to 7.02% for nicotine pouches. Loose leaf had significantly more moisture, approximately 45% greater than nicotine pouches. Among brands, Whitetail (loose leaf) had the highest moisture content, followed by Fully Loaded (loose leaf) and ON! (pouches), while DRYFT (pouches) exhibited the lowest moisture content. There appeared to be no apparent correlation in moisture content between labelled nicotine concentration and flavour types within the same brand (table 1). Product weights (per unit) ranged from 211 to 1940 mg, with chewing gum (1758 mg, SE=166) and lozenges (1500 mg, SE=87) having the highest mean weight, per unit, with pouches (298 mg, SE=85) and toothpicks (234 mg, SE=235) having the lowest. Product weights varied across different types, but consistency was observed within brands and strengths (online supplemental table 1). Weight for loose leaf were not calculated because the amount of leaf material placed in the mouth in each use will vary by the consumer.
The average total nicotine for all products was 6.56 mg/g (SE=0.93), with a range from 0.822 to 31.5 mg/g (online supplemental table 1). Broken down by product types, chewing gum ranged from 1.00 to 2.18 mg/g, loose leaf products ranged from 1.26 to 9.16 mg/g, nicotine lozenges ranged from 0.822 to 2.95 mg/g, toothpicks ranged from 5.06 to 6.18 mg/g and nicotine pouches ranged from 5.71 to 31.5 mg/g. Nicotine pouches contained the highest total nicotine content per product with the broadest range (1.41–8.11 mg/pouch), while toothpicks displayed the least total nicotine content (1.19–1.57 mg/toothpick). When comparing the total nicotine to the labelled strength, the measured nicotine content ranged from as low as 75% below the labelled value (eg, Rogue Peppermint 2 mg lozenges) to more than 58% above the indicated strength (eg, Rogue Fruit 2 mg chewing gum) (online supplemental table 1). Rogue lozenges (averaging 70% below) and Pixotine toothpicks (averaging 56% below) exhibited the highest deviations from the indicated strength. Although the nicotine content was unspecified on the packages for Revel and Velo lozenges, the values were found to be approximately consistent between the hard and soft labelled products (table 1; figure 1).
The levels of total and freebase nicotine found in 70 products by type, brands and labelled nicotine concentration. All levels shown are expressed in mg/g.
The average pH across the 70 products was 7.06 (SE=0.14), with values ranging from 4.68 to 9.49. This range resulted in the percentage of freebase nicotine varying from 0.0453% to 96.7%. Nicotine pouches exhibited the highest pH and widest range, with values ranging from 7.64 to 9.49, corresponding to freebase nicotine ranging from 30.8% to 96.7% (figure 2). Comparatively, nicotine pouches generally contained more (p≤0.0059) freebase nicotine percentage than other product types: 52.3% higher than lozenges, 24.4% higher than chewing gum, 45.1% higher than loose leaf and 51.5% higher than toothpicks (figure 3). ON! nicotine pouches, on average, displayed 1.5 times higher per cent freebase nicotine than DRYFT (table 1; figure 1). Additionally, on average, both the total nicotine and freebase nicotine (mg per product) in pouches demonstrated proportional increases with labelled strength. The percentage of freebase nicotine remained consistent within brands across different strengths, apart from ON! 8 mg, which exhibited a lower percentage of freebase nicotine.
Total nicotine (mg/g) by pH levels for 70 products by type and labelled nicotine concentration. The outlier box plots display the median, IQR, min, max and potential outliers. The pH levels ranging from pH 4.68 to 9.49, translating to 0.0453%–96.7% of nicotine in the freebase nicotine form.
Freebase nicotine percentage by product types. All levels shown are expressed in percentage. Error bars represent SEs.
Nicotine lozenges had the lowest pH with average value of 5.83 (SE=0.15) and a range from 4.68 to 7.49 representing levels of freebase nicotine from 0.0453% to 23.4%. When the percentage of freebase nicotine was calculated, nicotine lozenges were 27.9% (p=0.0012) lower than chewing gum and 52.3% (p<0.001) lower than nicotine pouches (figure 3). Although total nicotine content for ‘hard’ and ‘soft’ lozenges was similar, the differences were significantly higher in pH (p<0.001) leading to about five times higher per cent freebase nicotine in ‘hard’ lozenges compared with those labelled ‘soft’ (table 1). Revel ‘hard’ lozenges had eleven times higher freebase nicotine than ‘soft’ lozenges, while Velo ‘hard’ lozenges had three times higher freebase nicotine than ‘soft’ lozenges.
The percentage of freebase nicotine in loose leaf varied by brand ranging from 0.992% to 29.8%. Fully Loaded exhibited nearly four times more freebase nicotine than Whitetail in the lower labelled strength, while displaying twofold more in the higher strength (table 1). Two strengths of Whitetail were analysed, with 10.6 mg/g strength having two times the percentage of freebase nicotine and four times freebase nicotine (mg/g) than the lower labelled 5.3 mg/g strength. While Fully Loaded full strength and 50% strength had similar percentages of freebase nicotine, the full strength product had nearly three times more freebase nicotine (mg/g) than the 50% strength.
Discussion
The products in this study advertised nicotine content ranging from 2 mg to 8 mg. The measured total nicotine levels in these products reached up to 8.11 mg/product and the freebase nicotine levels reached up to 4.33 mg/product (online supplemental table 1). Our results show that the amount of total nicotine per product for ON! pouches and Rogue chewing gum is similar to the content listed on the packaging, while the amount of total nicotine in lozenges, toothpicks and DRYFT pouches is lower than the labelled (online supplemental table 1; table 1). Loose leaf products are advertised with nicotine content ranging from 5.3 mg/g to 10.6 mg/g. The measured total nicotine levels reached up to 9.16 mg/g and the measured freebase nicotine levels reached up to 1.14 mg/g (online supplemental table 1).
Freebase nicotine is the form of nicotine most readily absorbed across oral membranes and it varies depending on the pH levels of the products.11 On average, the levels and proportion of freebase nicotine in lozenges, gum, loose leaf and the toothpick products were much lower than in pouches (table 1; figure 1). In the nicotine pouches, the freebase nicotine—as measured by mg/g rather than mg/product—ranged from 2.15 mg/g to 16.8 mg/g, and the proportion of nicotine that was freebase nicotine ranged from 30.8% to 96.7% (online supplemental table 1; figure 1). Thus, of the products we tested, nicotine pouches had the highest levels of nicotine that is most easily absorbed by the consumer. Measuring the level and proportion of freebase nicotine by mg/g in addition to mg/product facilitates comparison across product types (eg, pouches and loose leaf). Furthermore, the patterns of use may vary widely by consumers, and it may be useful to understand the mg/g value of exposure to nicotine vs simply by unit of product.
When comparing products of the same brand and strength but different types, the sole difference observed was in the weight of the product. For instance, Rogue chewing gum weighed approximately three times more per unit than the Rogue lozenges. The total nicotine concentration in mg/product for chewing gum was three times higher than that of the lozenges. Additionally, double-strength products exhibited a total nicotine concentration two times the amount in mg/g of nicotine compared with original strength products. For example, the labelled Rogue 4 mg product had a total nicotine concentration that was two times the mg/g as the Rogue 2 mg product.
Oral nicotine products are distinct from FDA-approved NRT medications, which are available in the form of patch, gum and lozenge. Such medications have been approved by the FDA to help adults quit smoking. None of the products analysed in this study have been approved by the FDA for use as tobacco cessation aids. However, TFN gums and lozenges are marketed directly to consumers as an alternative to other tobacco products, as smoking cessation aids, or for recreational use.6 29–35 Some tobacco companies claim that their TFN gums and lozenges are produced from the same ingredients as smoking cessation medications, including polacrilex, in addition to other food-grade ingredients added for flavour and texture.30 31 The total nicotine concentration and pH levels in TFN gums and lozenges resemble those of commercially available, FDA-approved cessation products but are offered at a significantly reduced cost. Presently, cessation products are priced at approximately $0.50 per piece of gum and $0.70 per lozenge, whereas TFN products are priced 2–3 times lower, at $0.27 per piece of gum and $0.11–$0.27 per lozenge.30 31 36 Although the products may appear similar to consumers, TFN products are subject to different regulatory restrictions in terms of whether they can be sold and whether specific health or reduced harm claims can be made. For instance, Nicorette, authorised for use as a cessation product, falls under the regulation of the FDA’s Center for Drug Evaluation and Research (CDER), while TFN products, not authorised for use as cessation aids, fall under the jurisdiction of the FDA’s Center for Tobacco Products (CTP). CDER is tasked with assessing whether products are safe and effective for cessation, while CTP evaluates whether the marketing of products is appropriate for the protection of public health, and whether any claims of reduced risk can be made.37
Revel and Velo lozenges, according to the manufacturer’s website, are infused with nicotine extracted from tobacco plants and are produced in two different formulations, ‘hard’ and ‘soft’.30 The website indicates that both are made from the same ingredients, except the ‘hard’ nicotine lozenges do not contain acacia gum.30 The manufacturer’s website indicated that each lozenge contains 1.7 mg of nicotine.30 Both Revel and Velo had nicotine levels close to their indicated strength, varying from 21% above to 9% below the strength indicated on their website. The ‘hard’ lozenges, in both brands, have higher pH levels than the ‘soft’ lozenges, resulting in higher per cent freebase nicotine (table 1). In addition, Revel lozenges were re-introduced under the Velo brand name in 2020 by R.J. Reynolds Vapor Company.38 These similarities in patterns, weight of product, total nicotine and freebase nicotine of Revel and Velo can be observed in figures 1 and 2.
The only brand of toothpick in this study was Pixotine, a manufacturer of nicotine-infused toothpicks, whose website states that it aimed to offer a solution for smokeless nicotine/tobacco users dealing with hand-to-mouth actions and oral fixations.35 The website indicates that the product consists of nicotine derived from tobacco leaves and is sold in two nicotine strengths: zero nicotine or 3 mg.35 Although advertised as 3 mg per toothpick, the measured total nicotine content was about two times less than labelled, with a mean of 1.33 mg/toothpick (SE=0.85). The product had a pH of 6.75 (SE=0.41), resulting in a relatively low percentage (5.65%, SE=8.5) of freebase nicotine. The nicotine levels are low, comparatively, but if these products are intended to provide a solution for oral fixation as advertised, they may not be meant to replace conventional tobacco products.35 39
Fully Loaded and Whitetail Smokeless stated that their goal is to provide tobacco-free alternatives, with Fully Loaded’s additional stated goal is to create ‘a tobacco-free chew with the same satisfaction as conventional moist snuff’.33 34 They say their loose leaf products are made of either mint leaves or tea leaves or kudzu root with natural or artificial food grade flavour ingredients and sweetener.33 34 They say the nicotine in Whitetail is extracted from tobacco while Fully Loaded uses synthetic nicotine.33 34 Synthetic nicotine may contain various ratios of R- and S-nicotine isomers. The isomeric ratio content was not investigated so the potential effects cannot be commented on. Whitetail has higher nicotine content than Fully Loaded. However, Fully Loaded has higher pH than Whitetail, resulting in a higher percentage of freebase nicotine. The proportion distribution of these two brands results in similar amounts of freebase nicotine (mg/g) for the indicated lower and higher nicotine strengths (table 1; figure 1). Overall, the amount of total nicotine and freebase nicotine for full strength was two times the amount of the half strength when compared within the brand.
DRYFT and ON! pouches contain nicotine derived from the tobacco plant.30 32 Generally, the measured total nicotine ranged from 45% below and 1% above the indicated strength and the percentage of freebase nicotine was lower in the stronger-labelled nicotine pouches than lower strength. For example, the DRYFT 7 mg pouch exhibited approximately a 25% reduction in the percentage of freebase nicotine, on average, compared with the DRYFT 4 mg pouches (table 1; figure 1). On the other hand, the ON! 4 mg had approximately 4% difference in per cent freebase nicotine compared with the ON! 2 mg (table 1; figure 1). However, the ON! 8 mg had a significantly lower percentage of freebase nicotine, on average, compared with the ON! 2 mg and ON! 4 mg, exhibiting approximately a 50% reduction (table 1; figure 1). In addition, the ON! 8 mg varieties had the same percentage of freebase nicotine as the DRYFT 4 mg products.
The measured total nicotine and freebase nicotine levels of loose leaf and TFN pouches products were found to be comparable with those of conventional smokeless moist snuff and snus.40 41 The total nicotine content measured in TFN loose leaf products (1.26–9.16 mg/g) was lower than that of conventional moist snuff (11.3–16.7 mg/g).41 Fully Loaded and Whitetail Smokeless products (pH 5.69–7.63) resembled the pH of conventional moist snuff (pH 6.89–8.20).41 The total nicotine content of TFN pouches (5.71–31.5 mg/g) was similar to conventional snus (6.81–20.6 mg/g).40 Moreover, the pH levels measured in DRYFT and ON! nicotine pouches (pH 7.64–9.49) were similar to traditional snus (pH 5.87–9.10).40 These findings also align with recent published data on the pH levels of nicotine pouch products (pH 6.86–10.1) as reported by Stanfill et al.24
Nicotine pouches are unique products with a wide range of nicotine levels in both protonated and unprotonated forms.9 24 By using higher levels of nicotine salt and adjusting pH levels, manufacturers can produce products with varying nicotine levels and increased freebase nicotine.11 24 Tailoring the pH in nicotine products is crucial for enhancing nicotine absorption and satisfaction among users, which in turn can contribute to dependence and the progression to regular use.11 12 14 The nicotine pouches available at convenience stores reach up to 15 mg but those purchased online can go up to 34.4 mg in the USA; however, there are brands in Germany having measured nicotine content surpassing 50 mg with freebase nicotine over 90%.9 42 43 The information regarding the toxicity and addictiveness of these products is limited and further research into the safety of these high nicotine content pouches is necessary.
Conclusion
We investigated 70 products exhibiting varying nicotine content that are labelled or marketed as being ‘tobacco-free’. Among the samples analysed, lozenges demonstrated the lowest total nicotine and freebase nicotine content, whereas nicotine pouches exhibited the highest total nicotine and freebase nicotine content. Generally, products labelled with higher strength indicators tended to contain higher nicotine content than those advertised as lower strength. However, actual measurements revealed instances where the total nicotine content was lower than the stated amount in some products. The nicotine strength and availability, in terms of the amount of freebase nicotine, also varied across different types of products.
TFN products are marketed as containing nicotine extracted from tobacco plants or synthetically derived and as not containing tobacco lamina. These products may lack certain harmful constituents found in combusted or conventional smokeless tobacco products. Nicotine is highly addictive, however, and drives tobacco product use, which carries inherent risks. ‘Tobacco-free’ advertising of these novel oral nicotine products may impart a false sense of safety, including creating misperceptions about the addictiveness of the product. This is especially concerning as advertised nicotine values were found to be inconsistence with the actual values. Although consumers could use such products to help manage nicotine cravings and addiction, none of these products are approved for use by FDA as cessation aids. Chemical analysis of nicotine delivery products, and how that relates to product labelling, is vital in enhancing our knowledge of TFN product contents and their potential impacts on health. The data presented here can be used to inform consumers, public health officials and potential regulatory efforts concerning nicotine-containing products.
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
References
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors HT and RET conducted analyses, collected data, interpreted results, wrote the original draft and edited the manuscript at all stages. HT created tables and figures. LV, SS, MM and CHW also assisted with original draft writing and reviewing. HT is the guarantor, and accepts full responsibility for the work, had access to the data and controlled the decision to publish. HT, RET, LB and CHW designed the study, oversaw data analysis, assisted with writing at all stages and provided mentorship. All authors have contributed to editing of the manuscript, accept that it is ready for submission and accept responsibility for the contents of the manuscript. All authors have approved the manuscript as submitted to the journal.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention, the Public Health Service, or the US Department of Health and Human Services.
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.