Washington landlord, stockmarket player, and occasional nonprofit tobacco control organisation, the Truth Initiative, is back at it again. They exist to “amplify the truth about smoking, vaping, and nicotine”. In practice, they distort, filter, and manipulate the signal to their own discordant tune.
Their latest sleight of hand involves a study that compares the effectiveness of two nicotine pouches of different strengths (3mg and 6mg). However, the PR department at Truth Initiative isn’t happy to let the research speak for itself. Instead, they want you to believe it says something that furthers their agenda.
Truth Initiative hopes you’ll read the headline, but you won’t check the article.
First, check out some of these misleading headlines from articles written about the study.
The conclusion of the paper does not reflect these headlines. What it actually says is that “neither oral nicotine product relieved craving symptoms at 5 minutes as strongly as a cigarette.”
Let’s look a little deeper at the study to find the truth beyond the headlines.
The goal
"The goal of this randomised cross-over study was to evaluate differences in product appeal and plasma nicotine delivery associated with using ONPs of differing nicotine concentrations in a sample of adult people who smoke."
The study
The study took 30 people in rural Appalachia who smoke and asked them to visit a clinic in Columbus, Ohio, on three separate occasions.
On each visit, they used one of three products:
- 3mg nicotine pouch
- 6mg nicotine pouch
- Combustible cigarettes.
What was measured?
The study measured two things.
A) Plasma nicotine concentration after 30 minutes
B) Craving relief after 5 minutes
The results
The big result that the Truth Initiative has seized upon is the craving relief after 5 minutes part. They excitedly claim that "Nicotine pouches don't curb cravings, study shows."
But that’s not true. While nicotine pouches were less effective at curbing cravings than combustible cigarettes, the study doesn't support the statement that they don't curb cravings.
Thus, once again, we enter this strange universe where ostensible anti-tobacco campaigners are shouting from the rooftops that cigarettes are your best choice if you want to satisfy your cravings. That’s not anti-smoking advocacy. It’s the behaviour of an organisation that has lost the run of itself.
Is quick craving satisfaction the best way to evaluate harm-reduction products?
The thing is, the findings aren’t exactly surprising. Nor should they be. Nicotine pouches are an alternative to, not a replica of, cigarettes. For starters, the delivery methods are different. Nicotine pouches enter the bloodstream through the lining of the mouth and combustible cigarettes through the lungs.
Also, we need to consider that, for regular users, cigarettes are familiar, have a tactile element, and, of course, a satisfying throat. For me, those factors are what makes vaping a great alternative to cigarettes. So yeah, if you've smoked for years, the first time you use a nicotine pouch, it might feel like a compromise in terms of getting a quick hit of nicotine.
The question is, what are the factors that motivate people who smoke to move to harm-reduction products? Earlier this year, We Are Innovation ran an opinion poll on the usage of alternative nicotine products among former cigarette smokers. The study found that health (63%) and social (22%) were the top reasons people quit.
Now, consumers make health-conscious choices all the time, even if the alternative product lacks some of the lustre of the original product. Here are some examples off the top of my head.
- Stevia vs. sugar
- Grilling vs. frying foods
- Unprocessed foods vs. processed foods
- Olive oil vs. vegetable oil
- Low-fat dairy vs. full-fat dairy
If someone has a sweet tooth and you give them an orange, they might still express an ultimate preference for sweets. But will they be willing to compromise if they are motivated to improve their health?
After some time away from sweets, their taste buds will adjust, and natural sugars will taste better. Something similar happens with vapes and nicotine pouches for people every day.
Considering this, what if a health body was spinning dietary research and making claims like:
- “Stevia doesn’t curb sugar cravings, study says.”
- “Air frying won’t help people reduce oil intake: Study.”
- “Salad does little to curb McDonald’s cravings.”
It would be laughable if there weren’t a chance that someone would read the headline and assume that nicotine pouches are not worth trying in their journey to quit cigarettes.
How does this research stack up against nicotine gum?
In the 2013 book Interventions for Addiction: Comprehensive Addictive Behaviors and Disorders, Volume 3, one of the chapters talks about nicotine gum and says, "With nicotine gum administration, nicotine is absorbed through buccal mucosa, reaching peak plasma nicotine concentrations within 15–30 min, as compared to within 1–2 min after smoking."
What about other research?
In this study, "all subjects reported reduced cravings after the start of product use." It doesn’t limit the parameters to five minutes, which makes sense in the context of the product’s pharmacokinetics.
It is interesting to consider that the Ohio study may have deliberately selected the time frame of five minutes based on how pouches are absorbed. Many people use nicotine pouches in a more scheduled way, so if you wanted to test if they satisfy cravings, the study could have been set up differently.
Per the screenshot, the graph roughly tallies with the 30-minute peaks observed in the Ohio paper.
It's clear that the Truth Initiative is trying to frame the research inaccurately to undermine the potential of nicotine pouches. This approach is both irresponsible and bizarre behaviour from an organisation that is supposed to want to stop people from smoking.
Final thoughts
The Truth Initiative is an odd organisation. They’re pumped that a study of 30 people found that nicotine pouches are less effective than combustible cigarettes at reducing cravings within five minutes. They couldn't wait to spin that into a false claim that pouches "do little" to curb cravings. That's not what their researchers found, and it's not what other research has suggested either.
Washington bigwigs have been lying to and about rural Appalachian citizens for years. The Truth Initiative's framing of this study continues that shameful tradition.
Header Photo by Nijwam Swargiary on Unsplash
