We are seeing a rise in the use of recreational alternative tobacco and nicotine products, which includes vapes/e-cigarettes, heated tobacco products/heat-not-burn, snus and unauthorized nicotine pouches. Whilst these products are less harmful alternatives to traditional cigarettes,² they are gaining popularity,³ especially amongst younger consumers, and many formats still see nicotine inhaled via the lungs in high, addictive doses:⁴

• The average weekly nicotine consumption amongst vapers is more than double the amount of an average smoker.^{5, 6, 7}

• One in five recreational alternative tobacco and nicotine product users start using these products without ever having smoked, and hence are not using these as smoking cessation products.⁸

• Children aged 13-15 are using e-cigarettes at rates higher than adults in all WHO regions:

  • E-cigarette use among Canadians aged 16-19 has doubled between 2017-2022.⁹

  • The persistent effects of nicotine on developing brains means it is harder for adolescents to quit in the future.¹⁰

Increasing production and use of alternative tobacco and nicotine products, combined with unregulated disposal of single-use vapes/e-cigarettes, are beginning to have a detrimental impact on the environment. Their production and excessive use also come with financial burden to the individual, and potentially society, long-term.

• Continued nicotine addiction imposes a financial burden on users. It is well known that globally the prevalence of smoking is higher in disadvantaged communities and that smokers have a higher prevalence of mental health issues, such as anxiety and depression.¹¹ Early indications suggest this may also be true of vaping.^{12, 13}

Understanding this rising challenge, policymakers in some markets are beginning to regulate packaging, marketing, and flavour options of vapes/e-cigarettes:

• New regulatory requirements came into effect on August 28, 2024 under the Supplementary Rules Respecting Nicotine Replacement Therapies Order, requiring new labelling and advertising warnings for NRTs (which includes nicotine pouches in Canada), highlighting that nicotine is highly addictive and reinforcing that the products are only to be used by individuals 18 years of age and older. In addition to this, the new regulations introduced flavour restrictions and sales restrictions for novel formats, such as pouches. Novel formats can only be sold Behind the Counter and limited to mint flavour.¹⁴

• Globally, as many as 121 countries or territories regulate electronic nicotine delivery systems, based on a 2023 WHO report. This includes 33 countries that have moved to ban their sale, and 87 that have implemented regulations such as age restrictions on sales, bans on advertising and prohibiting vaping in public indoor areas.^{15, 16}

While health impacts of alternative tobacco and nicotine products are beginning to emerge, more research is needed into the long-term health risks associated with recreational alternative tobacco and nicotine products.¹

• A comparison of pulmonary effects of heat-not-burn (HNB) tobacco products shows immediate negative changes in exhaled carbon monoxide levels, oxygen saturation, and airway function immediately after use.¹⁷ The long-term use still poses a risk of exposure to carcinogens, especially when looking at the various additives found in these products.^18,19

• The addictive properties of nicotine frequently result in prolonged snus use, risking exposure to toxins that can impact overall health.²⁰

• Ingredients in recreational and non-traditional therapeutic alternative tobacco and nicotine products have well-documented adverse health impacts. For example, tobacco-specific nitrosamines (TSNAs), found in numerous unregulated nicotine pouch products and released by e-cigarettes are known carcinogenic chemicals and can harm blood vessels.¹⁹

• There are signs that e-cigarette vapour can irritate the lungs and might keep causing harm, especially in smokers with lungs already damaged by tobacco smoke.¹

We call on policymakers to prioritise a policy agenda that promotes and supports a Total Quit and make a commitment to working towards a tobacco and nicotine free future.

To support a global Total Quit, Kenvue recommends the following actions for government around the world:

• Implement comprehensive, evidence-based tobacco control policy frameworks at national levels.

• Ensure and prioritize a Total Quit by implementing endgame policies, including tobacco and nicotine free targets and ensuring access to cessation tools for all tobacco and nicotine users.

• Effectively regulate all tobacco and nicotine products.

• Future proof regulation to cover future innovation.

• Invest in long-term research on the health and societal impacts of alternative tobacco and nicotine product use.

• Promote public education on the risks of tobacco and nicotine and the benefits of Total Quitting.

As we navigate this evolving landscape of tobacco and nicotine use, ongoing and future-focused research will be essential to inform and shape effective management approaches for Total Quit.

_{1. Staudt, M. R., Salit, J., Kaner, R. J., Hollmann, C., & Crystal, R. G. (2018). Altered lung biology of healthy never smokers following acute inhalation of E-cigarettes. Respiratory research, 19(1), 1-10.}

_{2. Royal College of Physicians. Nicotine without smoke: Tobacco harm reduction. London: RCP, 2016.}

_{3. Tobacco Intelligence. What will the year ahead bring? Expected tobacco and nicotine regulation in 2024. https://tobaccointelligence.com/what-will-the-hear-ahead-bring-expected-tobacco-and-nicotine-regulation-in-2024/ . Last accessed December 2024.}

_{4. Giovacchini CX, Crotty Alexander LE, Que LG. Electronic Cigarettes: A Pro-Con Review of the Current Literature. J Allergy Clin Immunol Pract. 2022 Nov;10(11):2843-2851. doi: 10.1016/j.jaip.2022.07.009. Epub 2022 Jul 21. PMID: 35872217.}

_{5. Basis, 2023, Vaping Truths Diary Study, n=100.}

_{6. Healthline. How Much Nicotine Is in a Cigarette, Cigar, and Other Tobacco Products? https://www.healthline.com/health/how-much-nicotine-is-in-a-cigarette#nicotine-in-cigarettes. Last accessed December 2024.}

_{7. NHS Digital Health Survey for England 2021. Adults' health-related behaviours. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2021/health-survey-for-england-2021-data-tables. Last accessed December 2024.}

_{8. Incite 2024, Kenvue Global CEPs Usage and Attitude Report.}

_{9. WHO. Urgent action needed to protect children and prevent the update of e-cigarettes. https://www.who.int/news/item/14-12-2023-urgent-action-needed-to-protect-children-and-prevent-the-uptake-of-e-cigarettes. Last accessed: December 2024.}

_{10. Lydon, D.M., Wilson, S.J., Child, A. and Geier, C.F., 2014. Adolescent brain maturation and smoking: what we know and where we’re headed. Neuroscience & Biobehavioral Reviews, 45, pp.323-342.}

_{11. Action on Smoking and Health, 2019. Fact sheet No. 12: Smoking and youth https://ash.org.uk/wp-content/uploads/2019/08/ASH-Factsheet_Mental-Health_v3-2019-27-August-1.pdf}

_{12. Kock, L., Brown, J., & Shahab, L. (2020). Association of socioeconomic position with e-cigarette use among individuals who quit smoking in England, 2014 to 2019. JAMA network open, 3(6), e204207-e204207.}

_{13. Wamamili, B., Wallace-Bell, M., Richardson, A., Grace, R. C., & Coope, P. (2021). Associations of history of mental illness with smoking and vaping among university students aged 18–24 years in New Zealand: Results of a 2018 national cross-sectional survey. Addictive Behaviors, 112, 106635.}

_{14. Government of Canada. Order Amending the Supplementary Rules Respecting Nicotine Replacement Therapies Order: SOR/2025-9 https://gazette.gc.ca/rp-pr/p2/2025/2025-02-12/html/sor-dors9-eng.html}

_{15. U.S. News. Vape, E-Cigarette Sales Bans Around the World. https://www.usnews.com/news/best-countries/articles/countries-that-ban-the-sale-of-vapes-e-cigarettes#:~:text=Globally%2C%2033%20countries%20ban%20the,regulate%20the%20sale%20of%20ENDS.&text=Data%20from%20July%202023%20report. Last accessed December 2024.}

_{16. WHO. Report on the global tobacco epidemic, 2023. https://iris.who.int/bitstream/handle/10665/372043/9789240077164-eng.pdf?sequence=1. Last accessed December 2024.}

_{17. Pataka, A., Kotoulas, S., Chatzopoulos, E., Grigoriou, I., Sapalidis, K., Kosmidis, C., Vagionas, A., Perdikouri, Ε.I., Drevelegas, K., Zarogoulidis, P. and Argyropoulou, P., 2020. Acute effects of a heat-not-burn tobacco product on pulmonary function. Medicina, 56(6), p.292.}

_{18. Zendehedel K, Nyrén O, Luo J, Dickman PW, Bofetta P, Englund A et al. Risk of gastroesophageal cancer among smokers and users of Scandinavian moist snuff. Int J Cancer. 2008; 122:1095-1099.}

_{19. Mallock, N., Schulz, T., Malke, S., Dreiack, N., Laux, P. and Luch, A., 2022. Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches. Tobacco Control.}

_{20. Byhamre ML, Araghi M, Alfredsson L, Bellocco R, Engström G, Eriksson M, Galanti MR, Jansson JH, Lager A, Lundberg M, Östergren PO, Pedersen NL, Trolle Lagerros Y, Ye W, Wennberg P, Magnusson C. Swedish snus use is associated with mortality: a pooled analysis of eight prospective studies. Int J Epidemiol. 2021 Jan 23;49(6):2041-2050. doi: 10.1093/ije/dyaa197. PMID: 33347584; PMCID: PMC7825961.}

_{21. AP News – E-waste from electric devices is piling up and recycling isn’t keeping pace, UN available at: https://apnews.com/article/electronic-waste-kenya-united-nations-ewaste-environment-e37667e5a6b08fe8ef161d386eb3404d. Last accessed: May 2025.}

_{22. Turner, A., Scott, J., Backshall-Kennedy, T., Dabrowski, M., 20214. Deconstructing contemporary disposable vapes: A material and elemental analysis. Science of the Total Environment, 954. https://www.sciencedirect.com/science/article/pii/S0048969724064489?via%3Dihub. Last accessed May 2025.}

_{23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10542855/#:~:text=Disposable%20e-cigarettes%20and%20vaping,and%20are%20poorly%20recyclable15}