{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:15:41Z","timestamp":1791202541289,"version":"4.2.0"},"reference-count":42,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA14089"],"award-info":[{"award-number":["P30CA14089"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["P30CA2255520"],"award-info":[{"award-number":["P30CA2255520"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R01CA226917"],"award-info":[{"award-number":["R01CA226917"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["U54 CA180905"],"award-info":[{"award-number":["U54 CA180905"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["K01HL148907"],"award-info":[{"award-number":["K01HL148907"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015309","name":"Tobacco Settlement Endowment Trust","doi-asserted-by":"publisher","award":["R22-03"],"award-info":[{"award-number":["R22-03"]}],"id":[{"id":"10.13039\/100015309","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["K01DA055073"],"award-info":[{"award-number":["K01DA055073"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Tob Control"],"accepted":{"date-parts":[[2023,12,13]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Availability of flavours and potential modified risk tobacco product (MRTP) claims may influence young adults\u2019 (YAs\u2019) perceptions of and intentions to use nicotine pouches (\u2018pouches\u2019).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>\nYAs aged 21\u201334 years (N=47,\n<jats:italic>M<\/jats:italic>\n<jats:sub>age<\/jats:sub>\n=24.5,\n<jats:italic>SD<\/jats:italic>\n=3.1) with past-month nicotine\/tobacco use (10.6% cigarette-only, 51.1% e-cigarette-only, 38.3% dual use) and no intention to quit were randomised to self-administer four Zyn 3\u2009mg nicotine pouches in a 4 (flavour; within-subjects: smooth, mint, menthol, citrus) \u00d7 2 (MRTP claim on packaging; between subjects: present or absent) mixed-factorial design. After self-administering each pouch, participants reported appeal, use intentions and perceived harm compared with cigarettes and e-cigarettes. Three mixed-factorial analysis of variances (ANOVAs) examined main and interactive effects of flavour and MRTP claim on appeal, use intentions and comparative harm perceptions.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>\nMint (\n<jats:italic>M<\/jats:italic>\n=55.9,\n<jats:italic>SD<\/jats:italic>\n=26.4), menthol (\n<jats:italic>M<\/jats:italic>\n=49.7,\n<jats:italic>SD<\/jats:italic>\n=26.8) and citrus (\n<jats:italic>M<\/jats:italic>\n=46.6,\n<jats:italic>SD<\/jats:italic>\n=24.8) flavours were significantly more appealing than smooth (\n<jats:italic>M<\/jats:italic>\n=37.6,\n<jats:italic>SD<\/jats:italic>\n=25.4; p&lt;0.001). MRTP claim did not significantly affect product appeal (p=0.376). Use intentions were greater for mint (\n<jats:italic>M<\/jats:italic>\n=2.6,\n<jats:italic>SD<\/jats:italic>\n=1.3) and menthol (\n<jats:italic>M<\/jats:italic>\n=2.0,\n<jats:italic>SD<\/jats:italic>\n=1.1) flavours than smooth (\n<jats:italic>M<\/jats:italic>\n=1.8,\n<jats:italic>SD<\/jats:italic>\n=1.0; p=0.002). Flavour did not affect comparative harm perceptions (p values&gt;0.418). MRTP claims increased use intention (p=0.032) and perceptions of pouches as less harmful than cigarettes (p=0.011), but did not affect perceived harm relative to e-cigarettes (p=0.142). Flavour \u00d7 MRTP claim interactions were not significant.\n<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Flavoured (vs smooth) pouches were more appealing to YAs. MRTP claims reduced perceived harm of pouches compared with cigarettes; however, intentions to switch were low. To protect YAs\u2019 health, regulatory restrictions could target flavours and MRTP claims.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/tc-2023-058382","type":"journal-article","created":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T13:20:27Z","timestamp":1703596827000},"page":"315-322","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Effects of flavour and modified risk claims on nicotine pouch perceptions and use intentions among young adults who use inhalable nicotine and tobacco products: a randomised controlled trial"],"prefix":"10.1136","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7193-8720","authenticated-orcid":false,"given":"Erin A","family":"Vogel","sequence":"first","affiliation":[{"name":"TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3818-141X","authenticated-orcid":false,"given":"Alayna P","family":"Tackett","sequence":"additional","affiliation":[{"name":"Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9064-6603","authenticated-orcid":false,"given":"Jennifer B","family":"Unger","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria J","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Peraza","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA"},{"name":"Institute for Addiction Science, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki S","family":"Jafarzadeh","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA"},{"name":"Institute for Addiction Science, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5962-8586","authenticated-orcid":false,"given":"Michelle K","family":"Page","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6748-3068","authenticated-orcid":false,"given":"Maciej L","family":"Goniewicz","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA"},{"name":"Institute for Addiction Science, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1217-525X","authenticated-orcid":false,"given":"Adam M","family":"Leventhal","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA"},{"name":"Institute for Addiction Science, University of Southern California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,26]]},"reference":[{"key":"2025101704051679000_34.3.315.1","doi-asserted-by":"publisher","DOI":"10.1111\/ajad.13020"},{"key":"2025101704051679000_34.3.315.2","unstructured":"Tobacco control research group . 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