Advertising exposure and the appeal of emerging nicotine-containing products among people who have never used nicotine: findings from the Eurobarometer 2023.

Abstract

Introduction: Emerging nicotine-containing products, including heated tobacco products (HTPs) and nicotine pouches, have been growing in popularity in the European Union (EU). Advertising exposure impacts perceived product appeal and may contribute to product initiation. However, the current EU's Tobacco Products Directive lacks a consistent framework for regulating these advertisements. This study examines how exposure to HTP and nicotine pouch advertisements influences their appeal among people who have never used nicotine.

Methods: Data from the Special Eurobarometer 99.3 survey (May-June 2023) included 13 436 participants who have never used nicotine across 27 EU Member States. We estimated the weighted prevalence of HTP and nicotine pouch advertising exposure and perceived appeal and ran multilevel Poisson regression models adjusting for sociodemographic factors.

Results: 31.1% of participants reported HTP advertising exposure across the EU, with the highest levels reported in Romania (53.4%) and Slovakia (50.0%) and the lowest in Malta (13.6%). Nicotine pouch advertising exposure averaged 16.6%, peaking in Sweden (46.0%) and lowest in the Netherlands (5.0%) and Lithuania (7.7%). Product appeal remained low, with only 2.0% finding HTPs appealing and 1.3% finding nicotine pouches appealing. Exposed to HTP advertisements were 3.71 times more likely to find them appealing, while exposure to nicotine pouch advertisements increased perceived appeal of nicotine pouches by 5.78 times.

Conclusion: Advertising exposure was associated with higher appeal of nicotine-containing products among people who have never used nicotine. Given the risk of initiation, EU-wide advertising restrictions could protect this group and limit the impact of these products on health.