Alternative tobacco products differ from traditional cigarettes but still contain tobacco or nicotine. They have diversified how individuals consume nicotine, reflecting a shifting landscape in tobacco use.
What Are Alternative Tobacco Products?
Alternative tobacco products deliver nicotine or tobacco without the combustion of traditional cigarettes. They are categorized by their delivery mechanism and offer varied user experiences.
Electronic Nicotine Delivery Systems (ENDS)
Electronic Nicotine Delivery Systems (ENDS), or vaping products, include devices like e-cigarettes, vape pens, mods, and pod systems. These battery-powered devices heat a liquid, often called e-liquid or vape juice, containing nicotine, flavorings, propylene glycol, and vegetable glycerin. This process transforms the liquid into an aerosol that users inhale. Common types of ENDS include disposable, pre-filled, and refillable systems.
Heated Tobacco Products (HTPs)
Heated Tobacco Products (HTPs), also known as “heat-not-burn” products, are electronic devices that heat tobacco to a lower temperature than conventional cigarettes, preventing combustion. This releases a nicotine-containing aerosol without producing smoke. HTPs require specially designed tobacco sticks inserted into the device.
Modern Oral Nicotine Products
Modern Oral Nicotine Products and smokeless tobacco are designed for oral use without combustion. Nicotine pouches, for example, are tobacco-free pouches with nicotine and flavorings, placed between the gum and cheek or upper lip for absorption. Dissolvable tobacco products are powdered tobacco pressed into shapes like tablets, sticks, or strips that dissolve in the mouth. Snus, a moist snuff, is also placed orally; while traditional snus contains tobacco, modern versions are available.
Understanding Nicotine and Addiction
Nicotine, a compound found in the tobacco plant, is a highly addictive substance. When consumed, it rapidly reaches the brain, influencing its chemical pathways and contributing to its addictive properties.
Nicotine’s addictive effect stems from its interaction with nicotinic acetylcholine receptors (nAChRs) in the brain. Upon binding, nicotine stimulates these receptors, increasing dopamine release in the brain’s reward pathway. This surge creates pleasurable sensations, reinforcing nicotine use.
Continued nicotine exposure changes the brain’s reward system, leading to dependence. The brain adapts to nicotine, and dropping levels cause withdrawal symptoms like cravings, irritability, and anxiety. Since most alternative tobacco products deliver nicotine, they carry a substantial addiction risk.
Health Considerations and Risks
While some alternative tobacco products may expose users to fewer harmful chemicals than traditional cigarettes, they are not without health risks. They still pose concerns due to nicotine and other substances. Nicotine itself has adverse effects, including impacts on the cardiovascular system and potential developmental harm.
Electronic Nicotine Delivery Systems (ENDS)
Electronic nicotine delivery systems (ENDS) or vaping products have been linked to several health issues. E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) was identified, with symptoms including shortness of breath, cough, and chest pain. Vitamin E acetate, found in some THC-containing vaping products, has been linked to EVALI cases. Vaping aerosols can also contain heavy metals (like nickel, tin, and lead), volatile organic compounds, and ultrafine particles that can penetrate deep into the lungs, potentially causing inflammation and irritation. Cardiovascular stress is also a concern, as nicotine can raise blood pressure and heart rate.
Heated Tobacco Products (HTPs)
Heated Tobacco Products (HTPs), while producing fewer harmful chemicals than traditional cigarettes, still expose users to toxicants. They generate an aerosol containing nicotine, fine and ultrafine particles, carbon monoxide, and various organic compounds, including carcinogens like formaldehyde. HTP use can lead to acute respiratory and cardiovascular effects, such as increased heart rate and blood pressure. Long-term health effects are still under investigation, but short-term studies show impacts on lung function.
Modern Oral Nicotine Products
Modern Oral Nicotine Products and smokeless tobacco also present distinct health risks. Nicotine pouches, for instance, can lead to oral health issues such as gum irritation, inflammation, redness, and ulcers, potentially contributing to gum recession and increased sensitivity. They also carry cardiovascular risks due to nicotine content, including increased heart rate and blood pressure, which may elevate the risk of hypertension and heart disease. Traditional smokeless tobacco products are linked to gum disease, tooth decay, tooth loss, and the development of white or gray patches in the mouth called leukoplakia, which can become cancerous. Certain smokeless tobacco products are known to cause cancers of the mouth, esophagus, and pancreas.
A concern across all alternative tobacco products is their appeal to young people. Various flavors, such as fruit, mint, and candy, make these products attractive to youth. This raises concerns about nicotine addiction among adolescents and the potential for these products to act as a gateway to other tobacco use. Nicotine exposure during adolescence can disrupt brain development, affecting areas responsible for attention, learning, mood, and impulse control, potentially increasing the risk for future addiction to other substances.