As a pediatrician, I have seen firsthand the devastating impact nicotine addiction can have on young lives. That’s why I was encouraged by the most recent Healthy Kids Colorado Survey that found Colorado’s rates for youth e-cigarette use have dropped sharply thanks to years of advocacy, education and public policy change.
However, as we celebrate this achievement in public health, sales of a new nicotine product — nicotine “pouches” — are quickly on the rise. Many parents, caregivers and even health care providers aren’t yet familiar with this new trend that threatens the progress we’ve made in reducing youth nicotine use. Even more concerning is that Colorado, a state that prides itself on our commitment to health and wellness, provided incentives with taxpayer dollars to tobacco company Philip Morris International to build a nicotine pouch manufacturing facility right here in Aurora.
Now is the time for parents, caregivers and policymakers to take action to keep these addictive products out of our young people’s hands.
Nicotine pouches, such as the popular brand Zyn, are rapidly growing in popularity among youth, fueled by similar marketing tactics as those that led to the rise of JUUL and an epidemic of e-cigarette use among young people. While marketed as a “safer” alternative to smoking, nicotine pouches like JUUL deliver highly addictive levels of nicotine to their users. We know that youth brains are more vulnerable to nicotine’s effects, and that nicotine exposure during adolescence can have short- and long- term effects on attention, learning and memory.
Nicotine pouches are placed inside the mouth between the lip and gums, making it alarmingly easy for teens to use these products in schools and public spaces without detection.
The flavors offered in these products — such as peppermint, citrus, coffee and cinnamon — only add to the appeal to youth. Almost all youth that reported use of nicotine pouches were using a flavored product, highlighting the powerful — and familiar — role that flavoring plays in attracting young users. Combined with social media and influencer campaigns, there’s a scary resemblance to the tactics we saw drive the popularity of e-cigarettes among teens just a few years ago.
National data indicates a sharp increase in the sales of nicotine pouches in the United States, with a six-fold increase from 2019 to 2022. According to the 2024 National Youth Tobacco Survey, nearly 400,000 high school and middle school youth reported currently using nicotine pouches in 2023, double the number from 2021.
Notably, not all communities are harmed equally by nicotine consumption. A new report from the U.S. Surgeon General’s office recently laid bare the disproportionate impacts of nicotine and tobacco use. Thanks to the predatory practices of many nicotine product manufacturers, the brunt of health issues will be felt by our most vulnerable communities, especially youth who are Black, LGBTQ+ or living in lower-income households. The report specifically calls out that new products like nicotine pouches have the potential to undermine decades of progress in preventing and reducing young people’s use of nicotine and tobacco products.
Although Zyn — which leads the market share of nicotine pouches — has not yet been authorized for sale in the U.S., and the FDA has issued 119 warning letters to retailers engaged in the underage sale of Zyn, the state of Colorado announced this summer its support of a new Zyn facility in Aurora. Touted as a driver of jobs and economic growth, this decision raises ethical questions for the health of our youth and communities. As we saw with e-cigarettes, Philip Morris is introducing a new generation to nicotine addiction under the guise of “reduced harm.” Why are we allowing the manufacture and promotion of such a product in our own backyard?
As a pediatric professional who sees and treats kids who battle nicotine addiction, my message to parents and policymakers is that we must stay vigilant. New and deceptive nicotine products will continue to emerge and target young people, and if we don’t act decisively to protect youth from their dangers, we may see the progress we’ve made in reducing youth nicotine use unravel before our eyes.
Dr. Stacy Parra is a general pediatrician and President of the American Academy of Pediatrics, Colorado Chapter.
Well said, Stacy Parra.
Clearly the author doesn’t understand how production, distribution, and sales work. Simply having a manufacturing facility in Aurora has nothing to do with the ease or not of youth getting their hands on these. It doesn’t matter if Zyn was manufactured in Aurora or Nome, AK, if they’re sold at our local super markets and convenience stores that’s how the youth will get a hold of them. Are you making the same argument about all of the marijuana growers in the state? They’re basically doing the exact same thing, except they sell direct to the public.
The manufacturing facility isn’t going to sell their product to adults, much less kids. The author stated in her first paragraph what the solution is: advocacy, education and public policy change. If parents got smart about what it takes to be a parent, then the chances of kids wanting to try products like this will continue to be reduced. How about if we start holding people accountable rather than attacking businesses trying to help our economy?
Tobacco is a legal commodity. Adults are fully entitled to purchase tobacco products.
The obvious fact that state and local governments either can’t, or won’t, enforce the laws THEY passed is no excuse to remove tobacco products from retail stores. It’s de facto discrimination, and a deprivation of what is the lawful choice of purchasers who are of age, because the state throws up its hands.
It’s not the purchasers’ fault that government refuses to follow its own laws.
This is Merica! We don’t need no commie doctors trying to take our guns and our nicotine. We got our rights and if kids get hurt, that’s on them and their parents. I’m glad my tax dollars helped a multinational corporation build a building. If we don’t invest in the wealthy, nothing will trickle down. That’s how it works. Money Trumps ethics. Money Trumps health. Money Trumps life. Merry Christmas, Merica.