why ‘tobacco free’ doesn’t mean risk free

A habit that is worrying health authorities in Sweden where increasing numbers of teenagers^[1] are taking what’s known as “snus” is also concerning football authorities in England where one-fifth^[2] of professional players are regularly indulging because they say it improves their game.

White snus^[3] consists of small, tobacco-free pouches containing nicotine, plant-based fibres and flavourings. These pouches look a like a cross between a tea bag and a tablet of chewing gum, and they’re put between the lip and the gum to give users a burst of nicotine without some of the drawbacks of tobacco. Nicotine strength varies widely^[4] between different white snus products.

Traditional snus, a moist brown tobacco product, is almost exclusive to Sweden. However, the introduction of white snus – also known as nicotine pouches – has led to rapid global expansion^[5].

The rise in popularity of white snus around the world can be attributed to aggressive social media marketing campaigns where “Zynfluencers”^[6] are sponsored^[7] to promote white snus^[8] in their lifestyle content and the product is advertised across social media^[9]. While marketing for cigarettes and vapes is strictly regulated in the EU^[10], the rules for white snus are up to the individual countries to decide. Many countries don’t regulate white snus^[11] so consumers – even very young ones – can order the nicotine pouches easily.

It’s not just English male professional footballers who’re fans of white snus. In Sweden, 15% of young women aged 16-29 use white snus daily^[12], while only 2.5 % smoke cigarettes^[13] daily in the same age group.

Some commercials target women^[14] by suggesting that white snus offers a discreet “clean” way to feel the benefits of a nicotine hit. They highlight that users report a rush of endorphins that can relieve stress and pain and improve mood and memory^[15] – without the smell of cigarette smoke and the inconvenience of smoking or vaping breaks.

The marketing of white snus often stresses that they are “tobacco-free”^[16] because the pouches do not contain tobacco leaf. But that label can be misleading – the nicotine in these products is usually derived from tobacco leaves. Some also confuse tobacco-free with nicotine-free^[17]. Both these misconceptions can make consumers think that the pouches are safe^[18].

Advertisements often emphasise^[19] how white snus can be used anywhere and enhance social situations, while offering a variety of flavours from coffee to spearmint and black cherry, and serving as an alternative to cigarettes, vapes and traditional forms of tobacco.

Despite their growing popularity – and marketing attempts^[20] to associate white snus with healthier nicotine use – little is known about the specific health risks of white snus^[21]. But a lack of research into the effects of nicotine pouches does not mean they are safe.

The nicotine pouch was originally developed by a nicotine replacement therapy company in the early 2000s – but they didn’t gain traction until 2016 when the tobacco snus company Swedish Match introduced their product Zyn, which became a leading nicotine pouch brand in the US^[22]. Zyn is now owned by Philip Morris International, one of the world’s largest tobacco companies White snus is not an approved nicotine replacement therapy^[23], which means that it is not recommended as an aid to quit smoking.

Read more: Why nicotine pouches may not be the best choice to help you to stop smoking^[24]

While nicotine-free white snus exists, most products on the market contain nicotine. Nicotine is highly addictive, so many of those who try a nicotine product – no matter which one – will find it hard to stop using it. Nicotine has several effects on the body, including increased heart rate and activation of the brain’s reward system^[25], which contributes to its appeal.

Young people are especially sensitive^[26] to the addictive properties of nicotine. The wide range of white snus flavours available, often fruit, menthol or candy^[27], may further lower the threshold for use.

But research suggests that nicotine may also have a negative impact on brain development^[28]. Other potential risks include a negative effects on cardiovascular^[29] and oral^[30] health. But long-term effects specific to white snus remain unclear. Few studies have been conducted, and many of the existing ones have been sponsored by the tobacco industry. There is a need for large, independent, high-quality studies to assess long-term health risks.

With many young people using white snus, the unanswered questions about its health effects become more pressing. Until more research is available, it’s important to stay cautious: “tobacco-free” does not mean risk free.

References

1. ^{^} increasing numbers of teenagers (www.folkhalsomyndigheten.se)
2. ^{^} one-fifth (www.lboro.ac.uk)
3. ^{^} White snus (www.cdc.gov)
4. ^{^} Nicotine strength varies widely (academic.oup.com)
5. ^{^} rapid global expansion (youtu.be)
6. ^{^} “Zynfluencers” (www.theguardian.com)
7. ^{^} are sponsored (www.theguardian.com)
8. ^{^} to promote white snus (www.wsj.com)
9. ^{^} across social media (doi.org)
10. ^{^} strictly regulated in the EU (health.ec.europa.eu)
11. ^{^} white snus (doi.org)
12. ^{^} use white snus daily (www.folkhalsomyndigheten.se)
13. ^{^} only 2.5 % smoke cigarettes (youtu.be)
14. ^{^} commercials target women (journals.sagepub.com)
15. ^{^} mood and memory (www.sciencedirect.com)
16. ^{^} stresses that they are “tobacco-free” (doi-org.proxy.kib.ki.se)
17. ^{^} confuse tobacco-free with nicotine-free (doi.org)
18. ^{^} think that the pouches are safe (www-tandfonline-com.proxy.kib.ki.se)
19. ^{^} Advertisements often emphasise (doi-org.proxy.kib.ki.se)
20. ^{^} marketing attempts (nordicwelfare.org)
21. ^{^} health risks of white snus (doi.org)
22. ^{^} leading nicotine pouch brand in the US (pmc.ncbi.nlm.nih.gov)
23. ^{^} not an approved nicotine replacement therapy (www.cdc.gov)
24. ^{^} Why nicotine pouches may not be the best choice to help you to stop smoking (theconversation.com)
25. ^{^} activation of the brain’s reward system (perspectivesinmedicine.cshlp.org)
26. ^{^} especially sensitive (doi.org)
27. ^{^} fruit, menthol or candy (dx.doi.org)
28. ^{^} brain development (perspectivesinmedicine.cshlp.org)
29. ^{^} cardiovascular (doi-org.proxy.kib.ki.se)
30. ^{^} oral (doi-org.proxy.kib.ki.se)