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A Beginner’s Guide To Newer Nicotine And Tobacco Products: Nicotine Pouches, Heated Tobacco And E-cigarettes (Vapes)

A Beginner’s Guide To Newer Nicotine And Tobacco Products: Nicotine Pouches, Heated Tobacco And E-cigarettes (Vapes)

This article is from Dr Sophie Braznell, (Research Associate, Tobacco Control
Research Group) and Dr Rosemary Hiscock (Research Associate, Tobacco Control
Research Group). The Tobacco Control Research Group is part of the University of
Bath’s Centre for 21st Century Public Health. This article is intended to equip readers
with the fundamental information they need to be able to understand the available
evidence on these products and, in turn, improve decision making, such as whether
to recommend products to patients.

A Beginner’s Guide To Newer Nicotine And Tobacco Products: Nicotine Pouches, Heated Tobacco And E-cigarettes (Vapes)

Welcome to a beginner’s friendly guide to newer nicotine and tobacco products,
specifically electronic cigarettes, heated tobacco, and nicotine pouches. We’ll cover
each one in turn and then answer some frequently asked questions. This information
help you better understand emerging evidence on these products and navigating this
complex area of public health. Should you want to know more on this topic, check
out OncoDaily’s previous article on e-cigarettes, the Tobacco Control Research
Group’s work on heated tobacco products, and the newer nicotine and tobacco
product pages on TobaccoTactics.org.

What are newer nicotine and tobacco products?

Electronic Cigarettes (e-cigarettes)

Common names: e-cigarettes, vapes, ENDS (electronic nicotine delivery systems), and ENNDS (electronic non-nicotine delivery systems)

Key characteristics: E-cigarettes1 consist of a battery-powered electronic device that heat a liquid (often called ‘e-liquids’). The resulting emissions are then inhaled by the user. Some e-liquids are described as ‘a salt’ because the nicotine is present in the form of a dissolved salt2. Sometimes the device is sold separately to the liquid. These are known as pod or tank style e-cigarettes. Other e-cigarettes are sold pre-filled and ready to use. These are known as ‘disposables’.

Popular brands and key players (Euromonitor3 data): Many of the most popular brands globally are Chinese (SKE, Elf Bar and Lost Mary). Only around 21% of the market is controlled by Big Tobacco companies, i.e. world-leading cigarette manufacturers: Philip Morris International; British American Tobacco; Japan Tobacco; and Imperial Brands. British American Tobacco holds over 17% of the market with Vuse.

How are they being used?

The World Health Organization (WHO) estimated that e-cigarettes are used by over 86 million adults (16yrs+) and 14 million children aged 13-15 worldwide4. That’s about 2% of adults and 7% of 13-15-year-olds. The WHO also estimated children are nine times more likely on average to use e-cigarettes than adults, and, similar to cigarettes, more males use e-cigarettes than females. There is evidence e-cigarettes can help smokers quit and are possibly more successful than nicotine replacement therapies. However, many e-cigarette users continue to smoke cigarettes. This is known as ‘dual use’ and does not currently appear to lead to smoking cessation5.

E-cigarettes are also being used by people who had not previously smoked or used other nicotine products. This puts them at risk of adverse events and health damage6. Further, young e-cigarette users are around three times more likely to go on to smoke than non-users7.

Heated Tobacco Products (HTPs)

Common names: Heated tobacco products, heat-not-burn, tobacco vapour, tobacco heating system, modified risk tobacco product

Key characteristics: Heated tobacco products (HTPs) consist of a battery-powered electronic device that heats tobacco leaf. Most commonly, the tobacco leaf is held within a small, cigarette-like stick. Other HTPs, known as ՛hybrids՛, heat a non- nicotine or low-nicotine liquid and then pass the vapour through a pod containing the tobacco leaf. In either case, the resulting emissions are inhaled by the user. Most HTP brands sell the device and tobacco-containing element separately, often under different brand names. Popular brands and key players (Euromonitor data): This market is dominated by Big Tobacco companies, which control around 88% of the market, with Philip Morris International’s IQOS making up over 68% alone. Other global tobacco company brands include Glo, Ploom, Pulze and Lil.

How are they being used?

There is less data available on HTP use around the world, though sales have risen over recent years8. Data from 42, mostly higher-income countries gathered between 2015 and 2022 indicated around 5% of people had ever tried HTPs9. HTP use is most common amongst young adults10 and males11.

There is evidence suggesting the rise in HTP use has contributed to a decline in smoking in Japan12 – the biggest HTP market, where 11% used HTPs in 2025. However, globally HTPs do not appear to be helping smokers quit or even reduce their tobacco use13. This may in part be due to many HTP users continuing to smoke cigarettes (i.e. ‘dual use’). There are reports that HTPs can increase the likelihood of relapse14 among former smokers. HTPs are also being used by people who have not previously smoked15, with adolescents being over twice as likely as adults to have tried one16.

Nicotine Pouches

Common names: [oral] nicotine pouches, tobacco-free [oral nicotine/snus], modern oral, oral smokeless products, white snus, [upper/lower] ՛decky՛.
Key characteristics: Nicotine pouches17 typically consist of dehydrated nicotine, plus water, cellulose, flavours, additives, and sweeteners, all contained within a permeable pouch. Some use nicotine extracted from tobacco leaf and others use ՛synthetic՛ nicotine, which is created in a lab rather than from tobacco leaf. Users place the pouch between the lip and gum through which the contents can be absorbed into the bloodstream.
Nicotine pouches are sold in tins or cans of around 15-20 pouches.

Popular brands and key players (Euromonitor data): Big Tobacco companies control around 67% of the market, with Philip Morris International’s Zyn making up over 41% alone. Other Big Tobacco brands include Velo and Nordic Spirit. Further brands owned by American tobacco companies include On! and Rogue.

How are they being used?

Sales of nicotine pouches have grown rapidly over the last few years in many regions. In Sweden, where nicotine pouches were first launched18, 5% of people were using one on a daily basis in 202419. In the US, use has increased significantly, especially amongst men and younger age groups20. Use of other nicotine and tobacco products alongside nicotine pouches is also increasingly common21, particularly in youth and young adults22. Nicotine pouches are also being used by people who have not previously smoked or used e-cigarettes23.

There is limited evidence to date on24 whether nicotine pouches can help people quit. Claims they can reduce smoking rates are often based on evidence from Sweden25, where cigarette use is particularly low and snus use high. However, snus (tobacco- containing pouches) are not the same as nicotine pouches and strong tobacco control measures have also significantly reduced smoking rates in Sweden. Thus claims citing the ՛Swedish Experience՛ should be treated with caution.

There are reports of several pouches being placed in the mouth simultaneously and use of higher strength pouches expanding26. There are also reports of nicotine pouches being used in an attempt to enhance performance in sports27 and improve employees productivity in the workplace28. However, nicotine’s addictive properties lead to dependence and withdrawal symptoms that quickly undermine performance and productivity gains29.

 

Frequently asked questions

Do e-cigarettes emit water vapour?

The term ՛vape՛ can be misleading. While e-liquids do contain water, it typically makes up less than 10% of the total volume30. The majority is made up of humectants, like glycerin and propylene glycol31, which are thought to cause the dry mouth and throat32 commonly reported by users. The other key ingredient is nicotine – a highly addictive substance. The level of nicotine in e-liquids has repeatedly been found to be higher than the concentration written on the label33 by manufacturers and present in products labelled ՛nicotine-free՛. Other chemicals commonly found in e-liquids include flavouring compounds, trace metals, and potentially harmful chemicals, like carcinogens34.

Are HTPs a type of vape?

No. HTPs contain tobacco leaf. E-cigarettes do not. While nicotine is highly addictive, it is not thought to be the cause of some of the deadliest tobacco-related diseases. Tobacco leaf, when heated by HTPs, emits a substantial level of carcinogenic chemicals35. Conflating HTPs and e-cigarettes causes confusion and may mistakenly lead those seeking to only consume nicotine into using tobacco too.

Are nicotine pouches a type of snus?

Historically, ‘snus’ has been used to refer to pouches that contain tobacco leaf36. However, ՛snus՛ has started to become an umbrella term37 to refer to both tobacco pouches and nicotine pouches. The contents, level of evidence, and regulation38 on the two types of pouches differs greatly. Conflating them may imply the risks of one also apply to the other, and so it is important we are very clear in our terminology.

What are the harms of e-cigarettes, HTPs, and nicotine pouches?

E-cigarettes, HTPs and nicotine pouches have different contents and are used differently. So it follows that their risks will be different too. Some risks could be related to tobacco and nicotine content, like oral lesions39, and others can be independent, such as battery explosions40. It is not difficult to appear less harmful than cigarettes, which release over 7000 chemicals41 and kill up to half of users42. So, for an adult smoker, these products might lead to less disease – though opinions on this vary. To everyone else all three products pose significant risks of addiction and possibly also compromised health.

Many tobacco-related diseases take decades to appear. We are lacking the long- term, independent epidemiological data for these newer products. For example, there is evidence that e-cigarette use is associated with biomarkers43 reflective of increased risk of cancer but the overall evidence on cancer is still limited and can sometimes be conflated44 with risks from former smoking. In the meantime, the harms of these products are subject to ongoing, sometimes highly contentious, debate45. When weighing up the evidence for yourself, you may wish to consider whether the product: (1) reduces tobacco-related disease and death; (2) helps people quit smoking or nicotine altogether; (3) is being used by nicotine-naïve individuals, especially children; (4) poses new risks and harms; and (5) the quantity and quality of the evidence.

What about the environmental impact of e-cigarettes, HTPs, and nicotine pouches?

From production to consumption to disposal, these products cause significant environmental damage. Lithium used in batteries diverts it from more vital emission- reducing uses, for example in electric cars or hospital equipment. Most e-cigarettes are discarded in household waste. The lithium is then not recovered and during degradation there is leaching out of toxic chemicals46. Farmers growing tobacco for nicotine extraction for pouches use agrochemicals. Independent data on the greenhouse gas emissions for synthetic nicotine manufacture and transport are not yet available.

Can we trust the evidence on e-cigarettes, HTPs, and nicotine pouches?

A major limitation of the evidence for all three products is that much of it comes from companies that sell them, presenting a conflict of interest. Tobacco companies have a history of influencing science47 in ways that prioritise profits over public health. Little appears to have changed. Recent investigations have revealed how tobacco companies are: manipulating and misusing science to promote their newer products48; producing poor quality, biased science on HTPs49; and, more likely to report e- cigarettes50 and HTPs51 are less harmful than cigarettes compared to independent sources.

Although tobacco companies can go to great lengths to hide their influence, there are simple ways to spot possible conflicts of interest. For academic publications, check out the statements on author’s affiliation, funding and competing interests.

Other useful resources for investigating connections between a piece of evidence and the tobacco industry include Tobacco Tactics52 and the Tobacco Industry Allies Database53.

For more information

For more information on the topics discussed in this article, check out the following
links:

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A Beginner’s Guide To Newer Nicotine And Tobacco Products: Nicotine Pouches, Heated Tobacco And E-cigarettes (Vapes)

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