Counseling Adolescents about Zyn

Perhaps, because the hazards of cigarette smoking are so well known, many adolescents turned to “vaping” (electronic cigarettes) a decade ago. Using nicotine via vaping was perceived as less harmful. E-cigarettes such as Juul were wildly popular with teens until the U.S. Food and Drug Administration (FDA) banned the sale of these products to anyone younger than 18 because of increased concern for long-term consequences such as vaping-related lung injury (Rascon & Thomas, 2024).

Now a new form of nicotine use has soared in popularity among teens to the extent that it is being called a “craze.” The product, Zyn, delivers nicotine in a small pouch, flavored with mint or citrus, that is held in the mouth (often tucked under the lip) for an hour. Unlike cigarettes, there is no tobacco involved. Unlike vaping, there is no inhaling involved. Unlike snuff, there is no need to spit. Especially appealing to adolescents, Zyn can be used discreetly (for example, during school). It is readily available at gas stations and convenient markets. Popular magazine Time proclaims that “Zyn is starting to go viral” (Ducharme, 2024), and Tik-Tok videos posted by “Zynfluencers” are ubiquitous. Celebrities such as Tucker Carlson are “Zyn-thusiasts,” and the Zyn pouches have nicknames such as “lip cushies” (referred to as “upper-deckers” or “lower-deckers” according to the preferred mouth placement) (Semley, 2024).

This nicotine product is marketed for legitimate uses by adults trying to decrease cigarette smoking or vaping, and the FDA has not developed regulations to limit adolescent use. But concerns are surfacing because Zyn still delivers nicotine—which is a highly addictive substance. Swedish researchers conducted a randomized trial involving participants who already used snus (a product similar to Zyn but containing tobacco) (Lunell et al. 2020). In the laboratory, these participants were administered pouches of Zyn, snus, or American moist snuff. Zyn produced a significantly larger uptake of nicotine in systemic blood circulation when compared to snus or American moist snuff. Nicotine has known potential for cardiovascular harm (Ducharme, 2024). Former ear, nose, and throat physician Dr. Robert Jackler has pointed out the risk of dental problems such as cavities and gum disease, and recent studies have identified other side effects of Zyn such as mouth lesions and sore throat (cited in Ducharme, 2024). Most concerning is that Zyn users ages 15 to 24 also smoke or vape on the side, which deepens addiction to nicotine (Ducharme, 2024). U.S. Senate Leader Chuck Schumer recently spoke against Zyn being marketed to youth (Semley, 2024).

Although research on nicotine pouches has not yet produced sufficient evidence of harm for the FDA to ban its sale to youth, the highly addictive property of nicotine is already well established in science, and Zyn can contain low levels of potentially harmful substances such as formaldehyde (Ducharme, 2024). Universities, such as University of Nebraska-Lincoln, have begun disseminating information to students about the negative impacts of nicotine pouches on learning and attention span as well as their potential for addiction (https://health.unl.edu/nicotine-pouches-are-they-safer-chewing-smoking-or-vaping

Nurses and other health professionals have a responsibility to counsel adolescents about their use of nicotine, whether delivered by cigarettes, vaping, or Zyn pouches. Evidence-based approaches for smoking and vaping cessation can be applied when counseling teens about Zyn. Prochaska’s transtheoretical model of change is useful. This model has been successfully applied to smoking (Rascon & Thomas, 2024). The healthcare provider will promote client movement from precontemplation (Zyn user does not perceive a problem) through the subsequent stages of change (cutting Zyn consumption, ultimately achieving and maintaining cessation of Zyn use). Knowledge gained from research on smoking cessation interventions can be applied when counseling teens about Zyn. Aveyard et al. (2012) has demonstrated that nurse-delivered cessation counseling can be effective, even when relatively brief. Effective counseling includes educational materials, nicotine replacement therapy, and follow-up sessions (Duangchan & Matthews, 2020).

It behooves all of us to follow the ongoing research about Zyn, and I welcome your manuscripts on this topic.

Sandra P. Thomas
College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee, USA
[email protected]