United States: Nicotine products that are more concentrated and more attractive, an increased risk for young people

A new US report from the Truth Initiative[1] This highlights the rapid evolution of the tobacco and nicotine product market, characterized by the widespread availability of flavored products with high nicotine concentrations, widely accessible to young people. Despite a decline from the peak observed in 2019, e-cigarette use, combined with the rapid growth of nicotine pouches, maintains high levels of nicotine exposure among adolescents and young adults. The data reveal increasingly nicotine-rich products on the market, frequent use reflecting concerning levels of addiction, and a persistent gap between existing regulatory frameworks and industry strategies. These developments raise major public health concerns, particularly regarding the effects of nicotine on brain development and the increased risks of polydrug use.

The report is based on a cross-analysis of data. This data comprises, firstly, sales from retail outlets (Circana), covering sales of e-cigarettes and nicotine pouches between 2019 and 2024 in physical stores in the United States. Secondly, behavioral data from the TEEN+ (Tobacco Epidemic Evaluation Network) study, a national longitudinal cohort representative of children and young adults, were used. The results are primarily based on Wave 5 of the TEEN+ study, collected between August and December 2024 from individuals aged 13 to 27.

Products increasingly high in nicotine are linked to the widespread use of flavored disposable products.

The report highlights a particularly worrying trend in the e-cigarette market. While unit sales have been declining since 2022, the total quantity of nicotine sold has increased sharply. Between February 2020 and June 2024, the total volume of nicotine sold via e-cigarettes rose by 249 million tons, a change largely independent of the number of devices sold. This dynamic stems primarily from the transformation of the product range, now dominated by flavored disposable e-cigarettes.

These products represent over 93% of available % units at the end of 2024 and account for approximately 60% of total sales. Their design has evolved significantly, with a marked increase in e-liquid capacity, rising on average from around 2 ml to nearly 12 ml, as well as a rise in nicotine concentrations. By the end of the study period, disposable devices contained up to nine times more e-liquid than cartridge systems, resulting in increased and prolonged nicotine exposure.

This trend has been accompanied by a decrease in the price per milligram of nicotine, making these products particularly accessible to young people, who are more price-sensitive. In June 2024, the cost of nicotine delivered by disposable devices was just over a quarter of that observed for cartridge systems.

Flavors and technological devices: converging levers of attractiveness and reinforcement of addiction

The appeal of nicotine products to young people lies in the combination of flavors and increasingly technological devices. By 2024, more than four-fifths of e-cigarette sales were for flavored products other than tobacco, and almost all vaping teenagers and young adults reported using flavored products. Fruity, sweet, and menthol flavors dominate, masking the harshness of nicotine and facilitating initiation, which quickly leads to repeated use.

This sensory appeal is amplified by the emergence of so-called "smart" e-cigarettes. These devices are generally not legal, but they are proliferating on the market, incorporating screens, animations, puff counters, reward systems, and interactive games. In 2024, approximately one-third of adolescent and young adult vapers reported having used this type of device in the thirty days preceding the survey. These features contribute to normalizing vaping, encouraging compulsive behaviors, and associating nicotine consumption with a recreational activity and mechanisms of immediate gratification.

The combination of aromas and interactive technologies thus reinforces the addictive potential of these products, particularly among young people, whose neurological development is still underway, and promotes the early establishment of regular consumption behaviors.

Nicotine addiction and polysubstance use: intensive and cumulative use among young people

The data also highlight levels of use already associated with the development of addiction among a significant proportion of adolescents and young adults. Nearly 40% of adolescent vapers and more than half of young adults report using e-cigarettes at least twenty days a month. Among them, a quarter of adolescents (24.9%) and more than four out of ten young adults (40.2%) report daily use, reflecting consumption levels consistent with nicotine addiction. These consumption patterns also indicate high intensity, with some young people reporting using their device more than twenty times a day. Furthermore, more than half of users report feeling the need to consume nicotine within an hour of waking up, which is generally a recognized indicator of strong addiction.

These practices are frequently part of a pattern of multiple substance use. Nearly half of adolescent vapers and more than half of young adults combine e-cigarettes with at least one other tobacco product (particularly combustible tobacco) or other nicotine product (mainly nicotine pouches). More than three out of ten adolescent vapers (38.1%) report recent use of at least one combustible product, which remains the cause of most tobacco-related morbidity and premature mortality in the United States.

The combination of frequent use and simultaneous use of multiple products exposes young people to higher cumulative doses of nicotine and a greater diversity of harmful substances, increasing health risks and the risk of developing a strong and lasting addiction. This significantly complicates the challenges of managing cessation.

The rise of nicotine sachets and easier access: a new gateway for young people

The report highlights the rapid rise of nicotine pouches, now one of the fastest-growing categories. Between 2023 and 2024, sales nearly tripled, exceeding $400 million. These products, mostly flavored, are dominated by menthol and fruit flavors, which are particularly appealing to young people. While their prevalence remains higher among young adults, use is also increasing among teenagers, with a notable rise among high school students. Among young adult users, nearly a third report using them at least 20 times a month.

This trend is occurring within a context of continued easy access to nicotine products, despite age restrictions. A significant proportion of teenagers and young adults report obtaining these products online or through specialized physical retail outlets. Young adults, in particular, predominantly purchase directly from stores, highlighting the shortcomings of current age-restriction measures, even if the existing regulations were strictly enforced.

Restrictive policies are still insufficient in the face of a major public health challenge.

The report notes that, despite a scientific consensus on the effectiveness of sales restrictions on flavored nicotine products in reducing initiation and use among young people, regulatory frameworks remain largely inadequate. Existing systems remain fragmented, characterized by significant exemptions, particularly regarding flavorings such as menthol, and by inconsistent enforcement of market access rules. This situation fosters the continued availability of attractive, often unauthorized, products and allows manufacturers to quickly adapt their strategies.

These shortcomings have direct public health consequences. Early and repeated exposure to nicotine, in the context of incomplete brain development up to the age of 25, is associated with lasting effects on cognitive function, emotional regulation, and vulnerability to addiction. The combination of flavored, high-dose, technologically appealing, and readily available products maintains high levels of consumption and increases the risk of polydrug use.

In this context, the report calls for a substantial strengthening of public policies, based on comprehensive and coherent measures aimed at eliminating flavored and unauthorized products from the market, reducing accessibility for young people, and preventing the emergence of new forms of nicotine addiction. Protecting children and young adults from the nicotine industry thus appears as a public health imperative requiring an ambitious and fully implemented regulatory response.

©Generation Without Tobacco

AE

[1] Report, Monitoring a Changing Tobacco Product Market in the United States, Truth Initiative, published January 5, 2026, accessed January 7, 2026