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

Erin A Vogel; Alayna P Tackett; Jennifer B Unger; Maria J Gonzalez; Natalia Peraza; Nikki S Jafarzadeh; Michelle K Page; Maciej L Goniewicz; Melissa Wong; Adam M Leventhal

doi:10.1136/tc-2023-058382

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

Tob Control. 2023 Dec 26:tc-2023-058382. doi: 10.1136/tc-2023-058382. Online ahead of print.

Authors

Erin A Vogel¹, Alayna P Tackett², Jennifer B Unger³, Maria J Gonzalez³, Natalia Peraza^{3

4}, Nikki S Jafarzadeh^{3

4}, Michelle K Page⁵, Maciej L Goniewicz⁵, Melissa Wong^{3

4}, Adam M Leventhal^{3

4}

Affiliations

¹ TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA erin-vogel@ouhsc.edu.
² Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
³ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA.
⁴ Institute for Addiction Science, University of Southern California, Los Angeles, California, USA.
⁵ Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.

PMID: 38148143
DOI: 10.1136/tc-2023-058382

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, M _age=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.

Keywords: Harm Reduction; Non-cigarette tobacco products; Packaging and Labelling.

Grants and funding

U54 CA180905/CA/NCI NIH HHS/United States