Willingness to Use Commercial Nicotine Gums, Lozenges, and Gummies Among Nontobacco Using Adolescents in Southern California

Abstract

Purpose: New oral nicotine products (ONPs), often advertised as "tobacco-free" (i.e., pouches, gum, lozenges, gummies), come in nontobacco flavors appealing to adolescents. It is unknown how adolescent willingness to use ONPs differs by product type and flavor, and whether sociodemographic disparities exist.

Methods: Adolescent never tobacco product users (n = 1, 289) in ninth or 10th grade from 11 high schools in Southern California were surveyed in fall 2021 about ever and past 6-month use of ONPs and sociodemographic characteristics. Adolescents were randomized to view five different ONPs in either fruit or mint flavor, and asked to rate their willingness to use each product. Multivariable logistic random effect-repeated measures regression examined associations of product type, flavor, and sociodemographic characteristics with any willingness to use ONPs.

Results: Compared to traditional smokeless tobacco (willingness = 17.8%), adolescents reported greater willingness to use ONPs (gum, 28.2%; pouches, 21.1%; lozenge, 22.4%; gummies, 24.1%); adjusted odd ratios [aORs] 1.25-1.84; p-values<.001). Mint flavor (23.3%) compared to fruit flavor (21.4%), significantly increased odds of willingness to use across all ONPs (aOR [95%CI] = 1.15 [1.05, 1.26], p = .004). Younger adolescents (ninth, 24.2% vs. 10th grade, 21.4%) and LGBTQ+ (34.2%) versus heterosexual (19.7%) and cisgender (18.8%) adolescents were more willing to use these products.

Discussion: Adolescents reported greater willingness to use new ONPs compared to traditional smokeless tobacco. Adolescents who were younger (vs. older adolescents) or identified as LGBTQ+ (vs. heterosexual and cisgender) were more willing to use new ONPs. Efforts to monitor adolescents' willingness to use and actual use of these products are warranted.

Keywords: Adolescents; Oral nicotine products.

Figure 1.

Pictures oral products displayed participants in the experiment

Figure 2.

Willingness to use new oral nicotine products by product type and flavor^a,b. (A) is willingness prevalence by oral nicotine product type. (B) is willingness prevalence by product flavor (i.e., fruit or mint). Note.^a Analytic sample N=1289.^b Diflerences calculated using the χ² test. Groups not sharing numerals are significantly different in Bonferroni-corrected post-hoc pairwise contrasts. Error bars represent 95% confidence intervals.

Figure 3.

Prevalence of willingness to use oral nicotine products by sociodemographic characteristics.^a,b. Note.^a Analytic sample N = 1,289. ^b Differences calculated using the χ² test. Groups not sharing numerals are significantly different in Bonferroni-corrected post hoc pairwise contrasts.^c The “Another Race/Ethnicity” race/ethnicity category includes American Indian/Alaska Native, Black/African American, Native Hawaiian/Pacific Islander, White, multiethnic/multiracial, and other. ^d The “transgender, nonbinary” category includes transgender male, transgender female, gender variant/nonbinary, or other categories. ^e The “LGB+” category includes lesbian, gay, bisexual, asexual, queer, pansexual, and questioning. Error bars represent 95% confidence intervals. (A-F) represent ONP willingness prevalence across different sociodemographic characteristics.