What will it take for women who smoke to consider smokeless?

by Cheryl K. Olson, M.P.H., Sc.D, originally featured in the Tobacco Reporter.

When Brittney Niquette first tried smokeless tobacco two years ago, it was from a sense of obligation. She runs customer support for Lucy Goods, a maker of nicotine pouches, gums and lozenges.

“I like to know what our products taste like, so that I have a genuine opinion and feedback to give customers,” she explains. “They’re just not marketed to women. So I honestly didn’t know what a nicotine pouch was. I was thinking tobacco, like, brown in a pouch.”

Niquette started smoking at 15, repeatedly quitting and restarting. She now uses tobacco-free pouches every day. “My favorite is the berry citrus. And I like espresso flavor with coffee in the morning.”

In Scandinavian countries, widespread use of smokeless tobacco products has driven smoking rates to astonishing lows. In his recent article “Can alternative nicotine put the final nail in the smoking coffin?,” Karl Fagerstrom writes, “The availability and use of snus has contributed to Sweden’s record-low prevalence of smoking and the lowest level of tobacco-related mortality among men in Europe. This phenomenon is sometimes referred to as the ‘Swedish experience.'”

Public health modeling that factors in that experience and the low-harm chemical constituents of modern products suggest that a huge number of deaths could be averted if more people switched, as Niquette did, from cigarettes to smokeless. But so far, most of those switching, even to the newest smokeless alternatives, have been men.

“Of all adult smokers, about 45 percent are women, and 55 percent are men,” says Allison Bolyard, vice president for innovative nicotine products strategy at Altria. “But if you look at lifetime smokers who have successfully switched, only about one-third are women. We see a big opportunity in providing alternatives for women that they can enjoy and can be successful in switching, because they’re falling behind.”

In recent behavioral studies on smokeless products that I’ve conducted for industry, women described negative stereotypes about smokeless users. One said, “You kinda have to fight the dip mentality. Marketing needs to be classy and discreet. Not a country boy dip and spit.”

What innovations and approaches might get women who don’t want to quit nicotine to consider a smokeless alternative?

To better understand this, I talked with people in industry working to provide appealing options for women. I also collaborated with the Consumer Advocates for Smoke-Free Alternatives Association (CASAA) on a survey of its female members about their smokeless tobacco perceptions and experiences.

Deadly Misperceptions

Surveys consistently find that smokeless products are wrongly seen as more risky than e-cigarettes and often as more risky than smoking. A recent analysis of the nationally representative Population Assessment of Tobacco and Health Study found that a higher percentage of Americans believe smokeless tobacco products are more harmful than cigarettes than believe the (actual) reverse to be true. What’s more, “the study demonstrates that harm perceptions not only predict future product uptake in nonproduct users but also predict continued product use among existing users.”

Unfortunately, these misperceptions are even more widespread among women. Previous research found that among people in the U.S. and Canada who smoke, women were significantly less likely than men to agree with a statement that some types of smokeless tobacco are less harmful than cigarettes.

Daunting Barriers

Along with exaggerated fears of health risks, there are psychological and practical barriers to female interest in smokeless products. (More on these below.) One is outdated perceptions of smokeless products. Discreet modern products, such as tobacco-free nicotine pouches, do not involve what one CASAA member labeled “the nasty habit of spitting out the juice.” As Niquette’s story above implies, these small, white pouches bear little resemblance to the stereotype of a wet, brown wad of chew.

Another barrier is the unfamiliar mode of delivery. Bolyard previously oversaw Altria’s On! tobacco-free nicotine pouch line. She notes that users of traditional moist smokeless tobacco (MST) are about 95 percent male: “As opposed to men, women who smoke cigarettes aren’t used to putting, and parking, a product in their mouth.”

A third barrier is fear of being associated with negative stereotypes of smokeless tobacco users. In my previous research, smokeless users were perceived as being mostly men, “biker guys and baseball players.” There were mentions of “gross people” with brown or black teeth.

Based on this, women were reluctant to be observed using smokeless. One said, “Folks were noticing it [the round pouch tin] in my pocket and expecting me to spit somewhere.”

Unfamiliar, uncomfortable mouth sensations are a fourth barrier that may turn off women. In the CASAA survey, a number of women referred to “burn” or irritation as a reason for stopping smokeless use or avoiding certain brands.

“The familiar stinging/burning sensation on the gum when trying either snus or nicotine pouches is a huge deterrent to switch to smokeless oral products, especially for women,” says Bengt Wiberg, a Swedish economist turned snus advocate and innovator. His startup company, Sting Free, markets nicotine pouches with a patented shield technology that provides flavor and nicotine sans discomfort. “I think the U.S. expression ‘You only have one chance to make a first impression’ applies very much to this issue,” he says.

Wiberg also notes that today’s smaller, slimmer pouch products fit more comfortably in women’s mouths. Niquette seconded this, saying, “I could be talking to somebody, and you won’t know I have one in.”

Bolyard noted that Altria’s On! product was designed to minimize some of these barriers. The can is a square shape instead of an MST-like circle and includes 20 small pouches to match the typical cigarette pack size.

Unexpected Benefits

As women get better acquainted with smokeless products, they may discover unexpected benefits over other nicotine-delivery methods. Niquette appreciates the hands-free convenience of smokeless tobacco. “Women do so much stuff: We’re busy people–we cook, clean, raise kids. Sometimes your hands are full,” she points out. “So vaping or smoking is not an option.”

“I have three computer screens; I’m typing all day,” she adds. “And I don’t have to break. I can just grab a pouch out of the can, put [it] in my mouth and keep going.”

To ease the transition, Niquette suggests that women start with a smokeless alternative that comes in flavors they enjoy in other products, such as fruity or minty gum.

“Not Messy or Gross Like I Thought They Would Be”

Here is a selection of comments from 260 female members of the Consumer Advocates for Smoke-Free Alternatives Association on what makes women who smoke decide to try or reject smokeless tobacco products.

We defined “smokeless tobacco” as including nicotine pouches, snus, dip and chew. However, we learned that unfamiliarity with these products extends to the terminology. One wrote, “I’m confused; I thought vaping was smokeless tobacco?”

What would make women consider a smokeless product? The most common response was “nothing.” This included variations such as “threat of death,” “a million dollars,” or less hyperbolically, “a vaping ban.” However, a few respondents were open-minded: “I have no idea what it is, but this email was enough to have me interested. I currently vape.”

Factors listed that might make smokeless products appealing included: not having to spit, smaller size, “a bigger spectrum of flavors,” “cleaner,” “nonstaining” and “not noticeable to others.”

Few who had tried traditional moist smokeless tobacco found it appealing. One said, “It was convenient, and there was no annoying smoke, but it irritated my mouth a bit, and I worried about my teeth or developing cancer.” “The smell and the taste [were] overpowering, the ‘juice’ burned my mouth, spitting was gross, but swallowing was even worse,” said another.

But tobacco-free pouches, and to a lesser extent snus, found some favor. A user of both said they are “not messy or gross like I thought they would be and are advertised in the media.” Reasons for trying these products among those who use(d) them include not being able to smoke or vape at work or while traveling; wanting to quit vaping (“to give my lungs a break”), ease of access (“Vaping products became less available online … pouches were available at our convenience store”), ease of use, and curiosity.

Other positive comments included “Liked that it was discreet and just nicotine”; “It works just as well as the smoking of something, and it’s easy to just spit it out when you have enough”; “Use to get through the day at work without having to take a break. I liked how they curb cravings; the flavors and the size of the pouch makes it easy to be discreet”; and “Can do them anywhere. Try these pouches!! No smoke, but satisfaction given.”

Women who tried and stopped using pouches gave a variety of reasons. Some missed the “hand-to-mouth action–still wanted to smoke.” Others complained of hiccups, nausea or irritation: “I’m not a big fan of pouches because they burn the inside of my cheeks.” A few mentioned other sources of discomfort, such as “uncomfortable material that hurts my gums/mouth” or too much bulk. There was also just difficulty getting used to this type of product: “Flavors were good, but it was weird having something in my mouth that I wasn’t supposed to be chewing.” Some disliked the taste.

Because “smokeless” received various interpretations, many women left comments on other nicotine products, including gums, lozenges, tablets or sprays. These received a similar range of positive comments and complaints. This supports the idea that women seeking alternatives to cigarettes may have to try a variety of products and brands to find their fit. As one wrote, “Try it if it will benefit your health and you’re OK with it. To each their own.”

In short, it’s clear that many women hold strong, perhaps outdated stereotypes of smokeless tobacco.

Many will never try it. However, there appears to be an untapped demand for the benefits some women report from modern oral nicotine products: a discreet product to use where no smoke or vapor is allowed or a hands-free product that gives nicotine and flavor without effort.

McKinney RSA advisors are experts in perception and behavioral studies to help measure likelihood to use your smokeless nicotine products.

Our expert team can help guide you through the regulatory requirements and streamline the approval process. Contact us today online, or by phone (804) 461-3208 to learn more about how we can help get your products to market quickly and efficiently.