In the past decade, the market of tobacco and nicotine products has changed towards new nicotine-containing products. While a global decline in cigarette use has been ongoing for decades (World Health Organization, 2024b), there is now a growing use of other nicotine products marketed by the tobacco industry as less harmful than cigarettes (O’Connor et al., 2022). These new products include e-cigarettes and oral nicotine products often laced with sweet and fruity flavours. Such products have gained popularity among youth (O’Connor et al., 2022). Several Nordic countries have seen an increase in the use of e-cigarettes and oral nicotine products, including snus or nicotine pouches among school children and older youth (Kristjansson et al., 2019; Lund et al., 2024; Tokle & Bakken, 2023; Zetterqvist, 2024). This may be explained by the products’ colourful appearance and well-known flavours. Also, their discreet nature implies that the products can be used in places where smoking is normally prohibited, e.g., at school and in public areas (O’Connor et al., 2022).

This report will focus on the use of electronic cigarettes, in short e-cigarettes, and oral nicotine products. Heated tobacco products (HTPs) are not included in this report, as there is a low prevalence of use among youth in the Nordic and Baltic countries. Furthermore, cigarette use will be included as a reference to the newer products. E-cigarettes, some of them better known as vapes or disposables, come in many forms and shapes. Overall, they are battery-operated electronic systems where the users inhale aerosols created by heating up e-liquids, typically containing nicotine and other additives (National Institutes of Health; U.S. Department of Health and Human Services, 2020; World Health Organization, 2024a). Oral nicotine products are defined as non-combustible nicotine products and are delivered orally. These products are typically placed between the teeth and gum and deliver nicotine through the oral mucosa. This category of products includes snus (powdered tobacco leaves in pouches) and nicotine pouches (pouches containing nicotine salts, cellulose, and other additives but not tobacco) (Robichaud et al., 2020).

Several studies have shed light on the indisputable effect of structural regulations in reducing the use of cigarettes in both adult and young populations (Rod et al., 2024; Vestbo et al., 2018). It is critical to implement national regulations on new nicotine products, as more youth than ever are using the products at a younger age and international regulations have not addressed these products yet.

Nicotine is a toxic alkaloid originating from the tobacco leaves, where it serves as a defence mechanism against insects and other threats to the tobacco plant. Nicotine is the addictive component in tobacco products and is harmful to the human body (National Center for Chronic Disease Prevention & Health Promotion (US) Office on Smoking and Health, 2014), especially when used in adolescence (Vestbo et al., 2022). First and foremost, nicotine crosses the blood and brain barrier easily, causing neurological and cognitive impairments to the developing brain. This results in negative effects on the maturation of the brain and thus the development of attention, motivation, self-control, and emotional regulation (Jacobsen et al., 2005; Smith et al., 2015; Treur et al., 2015). Additionally, reverse associations between nicotine and mental health have been found, indicating that nicotine might induce symptoms of anxiety and depression (Goodman & Capitman, 2000; Johnson et al., 2000). Nicotine use in adolescence also increases the risk of damage to the oral mucosa and cardiovascular diseases later in life (Miluna-Meldere et al., 2024; National Center for Chronic Disease Prevention & Health Promotion (US) Office on Smoking and Health, 2014; Rungraungrayabkul et al., 2024; Vestbo et al., 2022).

The addiction to nicotine itself also has a negative impact on the everyday life of adolescents, i.e., feeling stuck in their addiction or experiencing that the joy of everyday activities is conditioned by nicotine use (Amato et al., 2021; Mathew et al., 2017; Vestbo et al., 2022). Also, the use of nicotine at a young age increases the risk of lifelong addiction and experimentation with other, potentially more harmful, substances. This is the so-called gateway effect of nicotine use (Yuan et al., 2015).

This report explores cross-national trends in the use of new nicotine products among youth from 2018 to 2024 across the Nordic and Baltic countries of Denmark, Finland, Iceland, Norway, Sweden, Estonia, Latvia, and Lithuania.

Furthermore, the report provides illustrations of national regulations, alongside the development of the use of nicotine products (cigarettes, e-cigarettes and oral nicotine products). The report seeks to inform and inspire future tobacco and nicotine prevention efforts at both national and international levels across the Nordic and Baltic countries.