Statement Highlights:  

• A newly issued American Heart Association policy statement summarizes the latest evidence on the impact of smokeless oral nicotine products on public health, identifies critical research needs for further understanding the implications for use of these products and identifies public policy solutions to reduce their use, especially in youth and adolescents.    
• The statement describes use patterns among youth and adults across geography, sex, gender, race and ethnicity; reviews potential cardiovascular and oral effects of smokeless oral nicotine product use and discusses public policy solutions supported by the Association to end tobacco and nicotine addiction in the U.S.  

(NewMediaWire) - December 03, 2024 - DALLAS—Smokeless oral nicotine products including nicotine pouches have grown in popularity among youth and young adults, and public policies are needed to curb their use, according to a new policy statement from the American Heart Association published today in Circulation, the Association’s flagship scientific journal. The Association, a global force for healthier lives for all, is celebrating 100 years of lifesaving work this year.

The policy statement reviews the latest research on the chemical composition of these products and their use patterns among youth and adults, details the health threats they pose and prescribes public policy solutions to prevent their use, especially in children and adolescents, toward the goal of ending tobacco and nicotine addiction in the U.S. and worldwide. According to the 2024 National Youth Tobacco Survey, nicotine pouches are now the second most popular tobacco product among youth. 

“The growing popularity of smokeless oral nicotine products, particularly among adolescents and young adults, has been fueled by tobacco industry marketing that is intended to get these and other populations addicted to nicotine,” said Cheryl R. Dennison Himmelfarb, Ph.D., R.N., American Heart Association volunteer, the statement’s lead author and vice dean for research and Sarah E. Allison endowed professor at the Johns Hopkins School of Nursing. “It is imperative to invest in more scientific research, support proven public policies that prevent and discourage use, and emphasize the importance of clinical support to curb the use of these dangerous products.”  

Oral smokeless nicotine products are non-combustible forms of nicotine that include smokeless tobacco like chewing tobacco, snuff, dip, or snus, nicotine pouches (such as  on! and ZYN) and other oral nicotine products such as lozenges, discs, tablets, gums and dissolvable tobacco products.  

These oral smokeless nicotine products, which have been marketed as ”tobacco-free,” have seen an increase in popularity due to their discreet use and variety of flavors. In addition, the tobacco industry spends more than half a billion dollars each year on advertising the products to specific populations and children. This has led to a growing amount of youth consumption and popularity among young adults. The Association’s statement calls for more research to fully understand the health effects of these rapidly growing new products.  

“These products contain highly addictive nicotine, which is dangerous to the developing brain, and many of them also contain a variety of chemicals, including carcinogens, that can be harmful to health,” said Rose Marie Robertson, M.D., FAHA, science and medical officer of the American Heart Association, co-principal investigator of the Association’s Tobacco Center of Regulatory Science and one of the policy statement’s authors. “It is imperative that we prevent youth and young adults from using these or any nicotine-containing products, and for adults considering these products to understand their risks.”  

Recognizing the profound health risks associated with tobacco use, the Association advocates for comprehensive policies at the federal, state and community levels, including increasing tobacco taxes, mandating tobacco retail licensure and eliminating all flavored tobacco products, including menthol, from the marketplace. These measures are essential for preventing youth initiation, reducing overall tobacco and nicotine use, and addressing the disproportionate impact of tobacco on vulnerable populations. Through these efforts, the Association aims to protect public health and promote a future free from the harms of tobacco use and nicotine addiction.  

The policy statement was prepared by the volunteer writing group on behalf of the American Heart Association’s volunteer Advocacy Coordinating Committee. American Heart Association policy statements position the Association on issues that will impact cardiovascular and brain health and mortality, guide our advocacy work at all levels of government, allow us to support the important work of others, and inform policymakers, practitioners, health care professionals, researchers, the media and the public.  

Authors, co-authors and members of the writing group are Cheryl R. Dennison Himmelfarb, Ph.D., R.N.; Neal L. Benowitz, M.D.; Melissa D. Blank, Ph.D.; Aruni Bhatnagar, Ph.D.; Paul J. Chase, P.hD.; Esa M. Davis, M.D., M.P.H.; Jessica L. Fetterman, Ph.D.; Brittney Keller-Hamilton, Ph.D., M.P.H; Oluwabunmi Ogungbe, Ph.D., M.P.H; Robert L. Page II, PharmD, PSPH; Mary Rezk-Hanna, Ph.D.; Rose Marie Robertson, M.D.; Laurie P. Whitsel, Ph.D.  

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.  

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Additional Resources:  

• Impact of Smokeless Oral Nicotine Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment: A Policy Statement from the American Heart Association
• Executive Summary
• Fact Sheet
• 2010: Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment: A Policy Statement from the American Heart Association  
• New and Emerging Tobacco Products and the Nicotine Endgame: The Role of Robust Regulation and Comprehensive Tobacco Control and Prevention: A Presidential Advisory From the American Heart Association
• Association news release: Good news and caution on youth tobacco use
• Association news release: New data show both improvement and concerning trend in youth tobacco use

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 - our Centennial year - we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact, our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.    

For Media Inquiries: 214-706-1173 

Julie Thomm: 304-444-1222; Julie.thomm@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721) 

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