Novel nicotine products: evolution, prevalence and health challenges

Abstract

Purpose to synthesize current scientific evidence on the evolution, prevalence, chemical composition, and health effects of novel nicotine products (electronic cigarettes, heated tobacco products, and nicotine pouches), as well as to identify effective approaches to the prevention and treatment of nicotine dependence within a public health framework. Materials and methods. This study is based on a systematic review of contemporary scientific literature, including epidemiological, clinical, and experimental studies, as well as international guidelines and reports from leading organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). Data from international surveys, including the Global Youth Tobacco Survey (GYTS) and the National Youth Tobacco Survey (NYTS), were analyzed alongside findings from systematic reviews and meta-analyses. Comparative and descriptive analytical methods were applied to assess prevalence, product composition, and associated health outcomes. Results. The findings demonstrate a significant increase in the use of alternative nicotine products, particularly among adolescents and young adults. In Ukraine, nearly 20 % of adolescents aged 13–15 report using e-cigarettes, with additional uptake of heated tobacco products and nicotine pouches. Nicotine is the primary pharmacologically active component across all product categories and acts on nicotinic acetylcholine receptors, stimulating dopamine release and reinforcing dependence. In addition to nicotine, aerosols from e-cigarettes and heated tobacco products contain propylene glycol, glycerin, flavoring agents, and toxic compounds such as formaldehyde, acetaldehyde, and acrolein, as well as heavy metals including nickel, lead, and cadmium. Although concentrations of certain toxicants may be lower than those found in conventional cigarette smoke, these products are not safe and retain significant harmful potential, including the ability to induce inflammation, oxidative stress, and endothelial dysfunction. Nicotine pouches exhibit considerable variability in nicotine content and allow rapid absorption through the oral mucosa, potentially leading to high peak plasma concentrations. Their use is associated with local oral lesions (e.g., gingivitis, gum recession) and systemic nicotine-related effects such as tachycardia, elevated blood pressure, and nausea. There is also a documented risk of acute nicotine poisoning, particularly among children. Nicotine exerts pronounced neurotoxic effects on the adolescent brain, impairing cognitive function, memory, and learning capacity, and increasing susceptibility to anxiety and depressive disorders. Additional adverse effects include negative impacts on the cardiovascular and respiratory systems. The phenomenon of dual use (simultaneous use of conventional and novel nicotine products) does not reduce harm but may increase cumulative toxic exposure. The widespread adoption of these products is further driven by aggressive marketing strategies, appealing flavors, and the dissemination of misleading information regarding their safety. Conclusions. Novel nicotine products are not safe alternatives to conventional smoking and pose a substantial threat to public health, particularly among young populations. Effective countermeasures require a comprehensive approach, including strengthened regulatory policies (e.g., restrictions on flavors, advertising, and accessibility), implementation of educational interventions, and increased public awareness. Primary healthcare providers play a critical role through the integration of routine screening, brief interventions (5A model), behavioral support, and pharmacotherapy into standard practice. The implementation of these strategies is essential to reduce the prevalence and adverse consequences of nicotine dependence at the population level.