Lost in the Labyrinth of Nicotine Products

In today's fast-paced marketplace of nicotine and tobacco products, navigating the options can be overwhelming for many Americans. Convenience stores now house a wide range of products, from traditional cigarettes to e-cigarettes, nicotine pouches, smokeless tobacco, snus, and heated tobacco products, often presented in eye-catching packaging and flavors that attract consumers.

Public health campaigns caution against the dangers of any tobacco use, while the FDA has allowed certain products to carry a modified-risk claim, asserting that switching to these products from cigarettes can reduce the risk of severe diseases. News reports highlight an epidemic of youth vaping, yet research shows that e-cigarettes may aid adult smokers in quitting.

Marketing strategies often showcase young, healthy-looking individuals participating in sports and emphasize "smoke-free" or "cleaner" experiences, while product warnings underline the dangers of use. An op-ed claiming that the risk of nicotine and tobacco products falls on a continuum, despite being sponsored by PMI Corporate Services Inc. (Philip Morris International), exemplifies this confusion.

Although no tobacco product is entirely safe, the FDA acknowledges that combustible tobacco products like cigarettes pose the highest health risks, and noncombustible products generally present lower risks. Consequently, the FDA has permitted some products to be marketed with a modified-risk claim, suggesting they lower the risk of several serious diseases.

As researchers in tobacco communication and regulatory science, the authors argue that public health agencies and healthcare practitioners must assist people in navigating this complex landscape. With the ever-changing nicotine and tobacco marketplace, communication about the varying harms should adapt accordingly. For those who do not use nicotine or tobacco products, the advice is clear: do not start.

Nicotine is addictive, and products containing it pose multiple risks, including cardiovascular diseases. For those who smoke cigarettes, quitting entirely is the optimal choice, and approved treatments such as nicotine patches, gum, and lozenges, as well as prescription medications, should generally be considered as initial interventions.

However, real life is seldom that straightforward. Some individuals repeatedly attempt to quit without success, while others have not yet decided to abandon nicotine and tobacco use. For them, understanding the differences in risk between persisting in smoking cigarettes and employing non-combustible nicotine and tobacco products can significantly impact their health.

Eliminating cigarette smoke exposure, even if someone persists in using nicotine and tobacco products, can lead to a considerable reduction in harm. Healthcare providers have recommended considering e-cigarettes as a smoking cessation tool for patients who smoke. Yet, as the market expands beyond e-cigarettes, doctors, public health agencies, and other trusted sources should be prepared to explain the continuum of risk among various nicotine and tobacco products, rather than focusing on a single product.

This does not imply providing smokers with a shopping list nor labeling vapes, nicotine pouches, or smokeless tobacco as harmless. It also does not mean endorsing the use of these products by those who do not currently use nicotine. Instead, it entails being transparent about the known facts: cigarettes are exceptionally hazardous, and nicotine makes them difficult to quit.

Some other products can deliver nicotine but carry substantially lower health risks. Switching entirely matters, and using cigarettes alongside another product does not provide the same level of risk reduction.

Ultimately, the authors assert that while no nicotine or tobacco product is entirely safe, it is crucial to communicate this information from credible and independent sources with no financial interest in selling these products. The conversation cannot be delayed, as individuals are already exposed to claims on ads and social media about the reduced harm of certain nicotine and tobacco products.

Influencers depict nicotine pouches as a lifestyle, discussing terms like "upper deckies" and the concept of being a "Zynner." Moreover, people will increasingly encounter modified-risk claims authorized by the FDA. If health professionals remain silent or offer oversimplified messages, the tobacco industry, social media, and word of mouth will fill the void.

Communication regarding the harm associated with nicotine and tobacco products should assist people in comprehending the growing array of products and the risks each carries.

Some may question whether acknowledging reduced-risk products sounds like endorsing the tobacco industry. Given the industry's history of deceiving consumers about the risks of tobacco, skepticism is understandable. However, failing to provide meaningful information backed by scientific evidence on the differences in risk is not the solution. The authors contend that one can accept two truths simultaneously: no nicotine or tobacco product is entirely safe.