From Additives to Advertising: WHO’s Call for Sweeping Tobacco and Nicotine Controls

The WHO's ninth report on tobacco regulation calls for stronger global policies to combat rising tobacco and nicotine use, especially among youth, emphasizing the need to regulate inhalation-facilitating additives, synthetic nicotine, and online marketing. It advocates comprehensive, evidence-based strategies to reduce tobacco-related harm and protect public health.

The World Health Organization (WHO) Study Group on Tobacco Product Regulation (TobReg), which includes experts from institutions such as Georgia State University, University of Pretoria, Imperial College London, and the American University of Beirut, recently issued its ninth report on the scientific basis for tobacco product regulation. This comprehensive report, created in response to global health needs and rising concerns over nicotine addiction, focuses on the role of regulatory measures in controlling a range of tobacco and nicotine products. With over 8 million deaths attributed to tobacco annually, the WHO emphasizes that comprehensive, evidence-based policies are critical to mitigating the global health burden caused by tobacco use. The study group’s latest findings cover multiple aspects of tobacco regulation, including the role of inhalation-facilitating additives, synthetic nicotine, nicotine pouches, and the impact of digital marketing on tobacco consumption. These aspects are particularly significant in light of new and emerging products that appeal to younger demographics and introduce new challenges for regulation.

Inhalation-Enhancing Additives Increase Health Risks and Addiction Potential

A key section of the report focuses on additives that facilitate inhalation, specifically, agents like menthol and synthetic cooling compounds. Such additives mask the harshness of tobacco smoke, making it easier to inhale and increasing the likelihood of habitual use, especially among young or novice users. The use of menthol and similar compounds in tobacco products enhances the sensory appeal, diminishing the discomfort that usually accompanies inhaling tobacco smoke. This altered experience raises concerns over increased tobacco initiation among youth, as the ease of inhalation potentially leads to rapid escalation from experimentation to dependence. Evidence presented in the report indicates that these additives play a substantial role in the progression from occasional to regular use, effectively enhancing the addictive properties of nicotine. The report advocates for a strong stance on regulating or banning these additives in all tobacco products to curb their widespread use, especially as they make products more appealing to non-smokers and young people.

Synthetic Nicotine Poses Regulatory Challenges and Expands Market Access

Another major focus of the report is synthetic nicotine, which presents unique regulatory challenges due to its chemical similarities to plant-based nicotine but distinct production process. Unlike traditional nicotine extracted from tobacco, synthetic nicotine is created in laboratories, making it difficult to track and categorize under existing tobacco laws. Synthetic nicotine’s structural and functional similarity to natural nicotine enables it to evade many regulations, allowing manufacturers to market products more freely, often without the restrictions typically imposed on traditional nicotine products. This loophole has significant implications for public health, as it broadens the range of nicotine products available to consumers, many of which are aggressively marketed to younger populations. The report calls for the development of robust international frameworks to address this regulatory gap, emphasizing the need for clear guidelines that include synthetic nicotine under existing nicotine and tobacco laws to protect public health.

Nicotine Pouches Appeal to Youth Through Flavors and Misleading Marketing

The study group also sheds light on nicotine pouches, a product gaining popularity due to its discreet and seemingly harmless appeal. Unlike traditional smoking products, these pouches are often marketed as safer alternatives because they don’t involve combustion or smoke, thereby promoting a false perception of reduced harm. The report cautions that while these products may appear less dangerous, they contain substantial levels of nicotine and are available in a variety of flavors, which further enhances their appeal among young users. These pouches have become increasingly accessible through online platforms, creating a pathway for underage users to experiment with nicotine in an unregulated environment. TobReg expresses concern that the flavored options and misleading marketing may encourage dependency among users who might not otherwise consider tobacco products. This concern is amplified by the difficulty in regulating online sales and advertising, especially on social media platforms, which are heavily used by younger demographics. The report suggests stricter controls on online marketing, particularly as it pertains to nicotine pouches and other non-combustible products, to protect youth from these emerging risks.

Biomarkers Offer New Insights into Health Effects of ENDS and Heated Tobacco Products

Additionally, the report emphasizes the role of biomarkers in evaluating the health effects of electronic nicotine delivery systems (ENDS) and heated tobacco products. Biomarkers are essential tools for measuring exposure levels and identifying potential harm, offering policymakers the scientific data needed to create informed regulations. By assessing specific biomarkers linked to respiratory, cardiovascular, and carcinogenic risks, the study group highlights the critical health concerns posed by these novel products, which are often marketed as reduced-risk options. However, the evidence shows that ENDS and similar products still carry significant health risks and require careful regulatory oversight. The report recommends further research on biomarkers to support regulatory science and better understand the long-term effects of these products on public health.

Unified Action and Stricter Policies Needed to Counter Industry Influence

The report concludes with a call for stronger international coordination to counteract the powerful influence of the tobacco industry, which continues to exploit regulatory gaps, particularly concerning new products and digital marketing. TobReg urges policymakers to adopt comprehensive regulations, including the prohibition of inhalation-facilitating additives, the implementation of stringent labeling standards, and stricter online advertising monitoring. These recommendations align with the WHO Framework Convention on Tobacco Control, which advocates for global action to reduce tobacco consumption and safeguard public health. By focusing on evidence-based measures, TobReg aims to provide the tools necessary for countries to address the evolving landscape of tobacco and nicotine products effectively, reinforcing the urgency for a unified approach to reduce tobacco-related harm worldwide. The report’s insights underscore that the path forward requires a concerted, science-driven effort to protect vulnerable populations from the harms of tobacco and nicotine, supporting the ultimate goal of achieving better health outcomes for future generations.