Flavored oral nicotine products that don't contain tobacco but aren't FDA-approved to help people quit are increasingly marketed and sold in the U.S., but researchers have never measured their use among U.S. teens.

In a new study published this week in the journal Pediatrics, researchers from the Keck School of Medicine at the University of Southern California surveyed more than 3,500 Southern California teens about the nicotine products they use.

New flavored oral nicotine products came in second: 3.4% of teens had used it at least once, while 1.7% had used it in the past six months.

E-cigarettes, also known as e-cigarettes, are the most popular nicotine product, used by 9.6% of teens at least once and 5.5% in the past six months.

Cigarettes, cigars, hookahs and other products are less popular.

"Surprisingly, these new flavored oral nicotine products were the second most commonly used product in our sample, after e-cigarettes," said lead author Alyssa F. Harlow, MPH, postdoctoral researcher.

Nicotine exposure during adolescence can impair brain development, cause problems with learning, memory and concentration, and lead to nicotine addiction.

"Our findings are concerning because these products are often high in nicotine, which we know is harmful to teens, and they're really easy to hide and hide. They also have the potential to appeal to teens with sweet flavors like cherry bombs and fruit. Mix," Harlow said.

The research team collected data in 2021 as part of the ongoing Southern California Adolescent Behavioral Health Study. Participants included 3,516 ninth and tenth graders from 11 high schools in Los Angeles, Riverside, San Bernardino, Orange and Empire counties.

After e-cigarettes, non-tobacco-flavored oral nicotine products (gum, lozenges, tablets, and gummies) are the most commonly used products. Combustible tobacco products ranked third, with 2% of teens reporting having used cigarettes, cigars, cigarillos or hookahs, and 1.3% having used one or more of these items in the past six months.

Fewer than 1% of teens have used other nicotine products, such as pouches or snuff, or have used them in the past six months. The use of flavored oral nicotine products was more common among teens who also used other nicotine products, such as cigarettes or e-cigarettes.

The researchers also found more use of flavored oral nicotine products among Hispanic teens, teenage girls, and teens who identify as LGBTQ.

"Some of these subgroups are young people who have been historically affected by tobacco-related disparities," Harlow said. "It's important for us to continue to monitor the use of these products among young people to determine the potential impact on these differences."

National surveys monitoring youth nicotine use, including the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the Food and Drug Administration's Population Assessment on Tobacco and Health, have not tracked new flavored oral nicotine products. Given the popularity of these products in the current sample, and the fact that they may appeal to young people,

Tracking their popularity among teens and young adults is critical, Harlow said.

"Right now, we don't really know what the public health impact is," she said. "That's why surveillance at the national level is really the first and most important step."

While these products can be harmful to teens, they offer a potentially less harmful alternative for adults seeking to quit smoking or vaping.

Harlow and her colleagues are studying young adult e-cigarette users to see how attractive new flavored oral nicotine products are compared to existing FDA-approved smoking cessation products.

They also continue to collect data from a sample of Southern California high school students and plan to conduct a longitudinal analysis of nicotine use to determine how use of flavored oral nicotine products correlates with other behaviors such as vaping and smoking over time relationship between.