Despite ongoing public health efforts, the increase in youth use of oral nicotine products does not mirror the surge seen in e-cigarette usage. Yet, the anti-Zyn campaign continues aggressively, potentially depriving millions of American smokers of safer alternatives and access to public health innovations that have significantly reduced smoking rates elsewhere.
The Centers for Disease Control and Prevention's recent "Notes from the Field" in the 2024 National Youth Tobacco Survey revealed findings on youth use of e-cigarettes and nicotine pouches, although full data on traditional tobacco use is pending.
While youth vaping has declined, the use of nicotine pouches, including brands like Zyn and On!, has risen slightly. Still, only 1.8 percent of U.S. middle and high school students reported using oral nicotine products in 2024 – up from 1.5 percent in 2023 but far below the 5.9 percent who were vaping. In fact, the percentage of U.S. youth using oral nicotine products in 2024 was 106.5 percent less than the number of youth who were vaping. In contrast, 22 percent of U.S. high school students reported drinking alcohol in 2023, and yet, nobody is talking about banning alcohol, which is more dangerous for teenagers.
Despite these figures, public health trade associations are vilifying the use of modern oral tobacco products despite them being significantly less harmful than combustible cigarettes. A July 31 blog post titled “ZYN 101: What to Know About Big Tobacco’s Latest Addiction,” by the American Lung Association (ALA), exemplifies this by amplifying fears and downplaying the reduced risk of oral nicotine products compared to cigarettes.
In a September press release responding to the 2024 NYTS data, the ALA labeled the “presence” of new products as “alarming,” yet failed to mention that less than 2 percent of youth used oral nicotine products this year. The release also focused narrowly on Zyn products, despite the availability of numerous other nicotine pouch options.
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Policymakers are also targeting nicotine pouches. A U.S. Senator has called for federal crackdowns and that “these nicotine pouches seem to lock their sights on young kids … and use the social media to hook them.” Similarly, Canada’s Health Minister recently inaccurately described nicotine pouches are a new loophole designed to hook children.
Policymakers should closely monitor the use of oral nicotine among youth, but also consider the potential for alarmist public health campaigns to inadvertently increase youth interest in these products.
This pattern is not unprecedented. In 2018, 12.9 percent of U.S. middle and high school students reported using e-cigarettes in the past month. Following alarmist declarations of an “e-cigarette epidemic” by the U.S. Food and Drug Administration and then-U.S. Surgeon General Jerome Adams, this figured surged to 20 percent in 2019, before declining to 13.1 percent in 2020 and 5.9 percent in 2024. These declines have occurred even while U.S. sales of e-cigarettes significantly increased.
More concerning is that the ALA’s focus on oral nicotine products like Zyn is undermining the science behind tobacco harm reduction. Decades of research have shown that the smoke from combustible tobacco is the primary cause of smoking-related harm, not nicotine. Nicotine, when used outside of combustible tobacco, poses significantly less risks to adults. Tobacco harm reduction products (including nicotine pouches) provide adults with nicotine without the harms associated with smoking.
While products like Zyn are relatively new, snus (a smokeless tobacco product that shares similarities with nicotine pouches) has been on the market for years and has helped people quite combustible cigarettes. The primary difference is that snus contains tobacco leaves, whereas oral nicotine products do not. Both deliver nicotine through a pouch placed in the mouth, but their health impact is significantly less severe than smoking.
Snus originated in the early 18th century in the form of moist snuff and was originally sold in loose form for the user to mold into a ball. In Sweden, pre-portioned miniature-sized teabag-like pouches were developed in 1973 and are now the predominant form of the product. Despite a European Union (EU) ban on snus since 1992, Sweden secured an exemption upon joining the EU. Currently, Sweden has the lowest smoking rate in Europe, with only 6 percent of the population reporting daily cigarette use in 2021. Swedish men, who have the highest rates of smokeless tobacco use and the lowest rates of cigarette use, also experience the lowest incidence of lung cancer and smoking-related diseases in Europe.
Oral nicotine products such as snus and nicotine pouches could help move the United States in the same direction by both reducing smoking rates among current cigarette users and providing a safer alternative for those who may otherwise start smoking. Public health initiatives should focus on minimizing the harm caused by tobacco use, rather than striving for an unrealistic goal of zero tobacco use.
For an organization that prides itself on its mission to “save lives by improving lung health and preventing lung disease,” the vitriol against a tobacco product that causes virtually zero harm to lung health is contradictory. Rather than espousing alarmist fears about a significantly less harmful nicotine product, the ALA should refocus its efforts on combatting the real threat to lung health: combustible cigarettes.
Lindsey Stroud is a Senior Fellow at the Taxpayers Protection Alliance.
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