If you're struggling to keep up with the different forms of tobacco and nicotine targeted at kids, don't feel bad. Most parents and caregivers are in the same boat, since manufacturers are introducing new products all the time.
If a product is labeled "tobacco-free," is it safe for young people? And what about newer alternatives like e-cigarettes and nicotine pouches that are wildly popular with Gen Z?
Here's what adults need to know about tobacco, nicotine and children's health, plus a look at the flood of products tobacco companies hope kids will try.
With or without smoke, nicotine is dangerous for your child
Nicotine is a natural chemical present in anything made with tobacco leaves. This covers a wide range of products, from cigarettes and cigars to "smokeless" alternatives like chew, dip and dissolvable tobacco.
Nicotine can be made in the lab, too—which is why some vapes and nicotine pouches can be labeled "tobacco-free." But ANY product that delivers nicotine will harm your child's health.
What else to know about nicotine:
Nicotine is a
stimulant that hits the human brain within 20 seconds, offering a dose of energy that may ease feelings of tension or stress. These pleasurable effects are just one reason that people who use it get hooked. In fact, research shows that nicotine is as likely to cause
substance use disorder as heroin or cocaine.
Nicotine changes the way our brains work. This may explain why it's linked with
learning and attention problems, especially in young people. And since your child's
brain will continue to grow and develop through age 25, the effects of nicotine can last a lifetime.
It affects breathing and circulation. Nicotine causes blood vessels to narrow, limiting blood flow to vital organs. Over time, your child's blood vessels will become stiff and less flexible, limiting the flow of oxygen and nutrients to every cell in their body.
Nicotine has been linked with
anxiety and depression in young people—another harmful effect that may be fueling the surge in mental health concerns our kids are facing.
Older forms of tobacco with new appeal for kids
Along with
cigarettes, many traditional forms of tobacco are seeing a resurgence in the U.S. Though
federal law prohibits retail stores from selling tobacco products to anyone under 21, enforcement has been challenging. Young people may also buy them online.
Unlike cigarettes, these products are usually made from whole-leaf tobacco tightly rolled inside a tobacco wrapper. Cigars and cigarillos differ only in size; both lack a filter to reduce tar and other harmful chemicals that cigarette smokers take in. (Little cigars are the smallest of these products and do have a filter tip.)
Because the nicotine content of cigar-style smokes is high—100 to 200 milligrams, as compared with 8 milligrams in a single cigarette—they put people who use them at high risk of substance use disorders. Smoking cigars of any size will raise your child's risks for lung, oral and throat cancer and serious respiratory issues like chronic bronchitis and emphysema.
This is a centuries-old way of smoking that uses a large glass pipe, often shared by multiple users in a hookah lounge or social gathering. Inside the pipe, tobacco is heated over a charcoal burner. Smoke enters a water-filled bowl that leads to a long, flexible tube with a mouthpiece. Other
names used for hookah include water pipe, narghile, argileh, shisha, hubble-bubble and goza.
Hookah tobacco often has real and artificial flavors (fruit, chocolate, mint and more). In a typical 1-hour session, people using hookah may inhale
100 to 200 times the amount of smoke they would get from just one cigarette.
Menthol is a chemical found in peppermint and other mint plants, but it can be made in the lab, too. Cigarette companies have long used it to reduce the burning sensation caused by inhaling tobacco smoke. As a result, people who smoke may breathe in more deeply and hold smoke in their lungs longer, leading to higher health risks and increased risk of substance use disorder.
Since the 1950s, tobacco companies have focused marketing campaigns on
specific groups, including Black people. As a result, more than 8 in 10 Black Americans who smoke use menthol cigarettes. The tobacco industry has also targeted Latino, Asian and LGBTQ+ people who smoke. Research shows that half of all kids age 12 to 17 who smoke old
prefer menthols.
Kreteks (clove cigarettes)
These unfiltered smokes are made with a blend of tobacco, cloves and other ingredients. Traditional in Indonesian countries but sold worldwide, clove cigarettes contain the same harmful chemicals as regular cigarettes, including nicotine. In fact, a 2021 review pointed to high levels of tar and carbon monoxide in kreteks, elevating users' risks for cancer, heart and lung issues and more.
Also known as beedis or biris, these are cigarettes typically made in India with shredded tobacco, hand-rolled in a tendu leaf and tied with string. Studies conducted in India show high rates of chronic bronchitis and other respiratory problems among people who smoke bidis, along with lung cancer risks 5 to 6 times higher than nonsmokers. In the U.S., bidis are sold online and in local tobacco stores.
This classic form of smokeless tobacco comes in a can, pouch or twisted plug and may include candy-like flavors. Users place a small amount between the cheek and gum, drawing out the tobacco flavor and spitting any excess. Nicotine and other harmful chemicals are quickly absorbed through the mouth lining. Chew, as it's often called, is closely associated with mouth, throat and pancreatic cancer as well as heart disease, gum disease and tooth loss.
These are powdered or shredded forms of tobacco that, much like chew, are placed between the cheek and gum or inhaled through the nostrils. Research links dip and pinch with the same health risks seen with chew, including dental disease, heart and lung issues and cancer.
Newer nicotine products that aren't safe for kids, despite what manufacturers say
Newer tobacco and nicotine delivery systems continue to grow as manufacturers bring more products to market.
When e-cigarettes first hit the U.S. market, many companies claimed they were a healthier alternative to cigarettes. Some ads even suggested that vaping could help people quit smoking or keep them from starting. But, just like cigarettes, these nicotine devices are highly addictive.
The most popular e-cigarettes contain highly concentrated
nicotine salts that deliver much more nicotine that traditional cigarettes. JUUL, once the most popular e-cigarette, contains
40 milligrams of nicotine in a single pod—roughly the amount someone who smokes would get from a full pack of cigarettes. Newer, disposable vaping products such as Elf Bar contain as much nicotine as 590 cigarettes!
Disposable e-cigarettes: more popular, more addictive?Disposable vapes were the
most common type of e-cigarette used by U.S. young people in 2023. This has health experts concerned.
Teens and young adults using disposable e-cigarettes
report more frequent and continued use of them, compared to peers using devices that must be recharged or refilled with nicotine liquid or pods. Disposable vapes come in various candy-like flavors, unlike non-disposable e-cigarettes that are more strictly
regulated.
Along with nicotine, kids who vape may also absorb toxic metals and
acrolein, a chemical known to cause liver damage.
This smokeless tobacco product comes in small pouches containing powdered tobacco that fit under the upper lip. Originally from Sweden, snus is now made in the U.S. by major tobacco companies. Young people may like snus because, unlike other smokeless products, it doesn't require spitting.
Snus are often promoted as a way to help people quit cigarettes. However, since it delivers nicotine and other cancer-causing agents, however, snus poses serious risks for substance use disorder, cancer and heart issues.
Marketed by a European company owned by tobacco giant Phillip Morris,
nicotine pouches sold under the ZYN brand have captured wide attention in the U.S. This is thanks to social media "ZYNfluencers" who generated millions of views on TikTok alone.
Unlike Swedish-style snus, nicotine pouches contain no leaf tobacco. Labeling these products as tobacco-free might make them seem healthier than other alternatives, but their nicotine content makes them addictive and harmful to growing bodies.
Of all smokeless products, this one may come closest to candy in its appeal to young users. Dissolvable tobacco comes in sticks, tablets, small pellets shaped like breath mints or lozenges or thin strips that melt in the mouth. There are even
Nicotine gummies are also among the most popular
non-tobacco oral nicotine products used by adolescents.
These products come in tasty flavors and don't cause users to spit, so they can be used anywhere. Because they usually deliver more nicotine than cigarettes, children may eat too many, raising risks for
nicotine poisoning.
Nicotine chewing gum
Nicotine gum has long been available as a
tool to help quit smoking, but newer products are marketed for
nonmedical purposes. Modern packaging can make it easy to conceal and also easily confused with regular gum, which could lead to unintentional nicotine poisoning.
These are also called "heat-not-burn" or "smokeless" tobacco products. Rather than liquid vape "juice," brands such as IQOS use compressed ground tobacco heated by an electronic unit that generates an aerosol. They deliver about the same level of nicotine as cigarettes, so are just as addictive. Heated tobacco users also breathe in carbon monoxide, heavy metals such as arsenic, lead and mercury and other toxic chemicals.
How to talk with your child about nicotine, tobacco and lifelong health
The American Academy of Pediatrics (AAP) has taken
a strong stand against nicotine and tobacco use for kids. Our policies follow clear evidence that nicotine and tobacco in ANY form are bad for growing bodies and brains.
Parents, guardians and other caring adults can make a real difference in helping kids adopt an informed perspective about tobacco and nicotine. Here are tips for opening a healthy conversation with your child:
Know your facts. Understanding why tobacco and nicotine are harmful will help you feel confident and prepared to answer any questions your child might have.
Take a stand, but don't preach. Older kids are focused on building independence. This means they often reject a parent's point of view, especially if they feel judged or pressured to agree. A more effective way to talk to tweens and teens is to emphasize how much you love them. Any concern about tobacco and nicotine reflects your hope that they'll live a long, healthy life.
Address your own tobacco or nicotine use. If you use one or more of the products listed in this article, your child might wonder why they shouldn't try them too.
Quitting can be tough, but it will set a positive example for your child. Even if you don't quit, you can be honest with your child: "The truth is, I wish I had never started. I'm hoping you won't."
Talk with your child's doctor. Pediatricians and family physicians are ready to support you in keeping children away from tobacco and nicotine products. Hearing this message from many different adults, including doctors, can help kids develop healthy perspectives about smoking, vaping and other health issues.
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