Oral nicotine pouches: Rising popularity of a new class of tobacco products among youth.

Oral nicotine pouches (ONP) are an emergent class of tobacco products, which have significantly risen in popularity among youth. Unlike combustible cigarettes or smokeless tobacco that are made of tobacco leaves, ONP are comprised primarily of nicotine, mixed with flavorings, humectants, artificial sweeteners, stabilizers, pH adjusters, synthetic cooling-agents, and plant-based fillers. ONP are marketed as "tobacco free"/"clean"/"flavor-ban-approved" and promoted as a less harmful alternative to other tobacco products and a means to smoking cessation. However, no to very uncertain evidence exists on the harm-reduction potential of ONP. Additionally, the long-term health effects of ONP use are unknown. There is growing evidence on the presence of trace amounts of various toxic and carcinogenic compounds in ONP. Of further concern are challenges in ONP regulation and pervasiveness of social media marketing, which facilitates widespread misinformation and easy access for minors, overriding existing age restrictions. The potential for widespread and lifelong nicotine addiction, the unknown long-term health effects, and the societal costs associated with ONP use underscore the need for cross-cutting research on ONP. Empirical data on the health impact and societal costs of ONP use are needed to inform effective prevention and surveillance strategies, stringent regulation, and targeted public awareness campaigns, thus helping protect the well-being of ONP users, particularly the developing and vulnerable population of youth.