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• The brain is still developing until the age of 25. What do you think that means for young people who start using nicotine?
• In the video, either skills or addiction and anxiety are strengthened depending on what we do. What do you do that strengthens your brain?
• Why do you think nicotine can increase the likelihood of people turning to other drugs?

Task: Write down three things you want to get better at. Discuss how nicotine could affect them.

• The Frekjudós starts out as a cute little dog. Why do you think nicotine addiction starts out so innocently?
• What are the signs that the Frekjudós is in control, not the person?
• In the video, use eventually becomes about reducing discomfort, not about feeling good. What do you think about that?
• What can you do if you feel the Frekjudós has taken over?

Task: Draw or describe your own “Frekjudós”. What does it demand, and how can you say no to it?

• How many hours do you sleep a night? Is it enough?
• What happens in the body while we sleep, according to the video?
• How do you think poor sleep affects school, training and well-being?
• What else besides nicotine can disrupt young people’s sleep?

Task: Keep a sleep diary for a week and look at what affects your sleep.

• Which effects of nicotine on the body surprised you most?
• How do you think nicotine affects performance in sport?
• Many people only think about the lungs when tobacco is discussed. Why are the mouth and gums often forgotten?
• Would knowing that nicotine pouches can cause gum recession change anyone’s opinion of them?

Task: Create a short social media post (text, image or video) explaining to your peers how nicotine affects the body.

Three addresses were given at the seminar.

Jóhann Steinar Ingimundarson, Chair of UMFÍ

Link to the address: https://vimeo.com/790811758

Alma Möller, Director of Health.

Link to the address: https://vimeo.com/835385428

Willum Þór Þórsson, Minister of Health.

Link to the address: https://vimeo.com/790824702

Lára Sigurðardóttir, physician and PhD in public health sciences

Lára points out that despite the large amount of information about the harmful effects of tobacco, there is still very little research on nicotine pouches. Yet the product is advertised as low-risk, which is not supported by evidence; the pouches cause various side effects and, for example, disrupt the neurodevelopment of young people’s prefrontal cortex. Nicotine gives the user a sense of well-being at first but quickly stops having positive effects. On the contrary, it increases the likelihood of feeling unwell, has a negative effect on the most important stages of sleep and reduces the ability to learn and concentrate. Lára believes there is a great need for more research, as use among young people is increasing but there are few if any regulations around nicotine pouches. They contain many times more nicotine than tobacco, and the higher the amount, the greater the risk of becoming addicted. Nicotine is almost always the first addictive substance for those who go on to other substances, and use usually starts in childhood. Lára wonders whether society is too tolerant of nicotine use by young people, who do not have the judgement and maturity to understand the risk.

Link to the talk:

https://vimeo.com/790817062

Ideas for discussions and/or projects for young people:

• Nicotine pouches have still been little studied, but a lot is known about the harmful effects of nicotine – which of them are mentioned in this talk? Why and in what way is it more dangerous for young people to use nicotine than older people? And why do you think nicotine use among young people is increasing?
• What conclusions can be drawn from the fact that tobacco manufacturers (tobacco still kills more than 8 million people every year) also produce nicotine pouches (and e-cigarettes), and often market the product specifically to teenagers?

Stefán Pálmason, dentist and specialist in oral medicine

Stefán talks about the effects of tobacco and nicotine on the mouth. There are several different types of oral tobacco, with big differences in the amount of carcinogens they contain. Nicotine pouches are the newest product and their long-term effects are not yet known. The risk of oral cancer from them appears to be low if any, but there is uncertainty, as the pouches are still largely unstudied. It is clear, however, that the pouches cause considerable chemical irritation and can cause various problems in the mouth, such as gum recession, tooth discolouration, bone bulges, increased connective tissue and sores that do not disappear even when tobacco or nicotine use stops.

Link to the talk:

https://vimeo.com/790822958

Ideas for discussions and/or projects for young people:

• Is the risk of cancer the only thing that should deter people from using nicotine pouches? What about the problems and visible effects that Stefán lists?

Sylvía Runólfsdóttir, physician at Vogur hospital

Sylvía discusses treatment for nicotine addiction and how to support young users in quitting. Nicotine is extremely addictive, withdrawal symptoms appear immediately and cravings last a long time. It is therefore hard to quit, but with support and the right tools it is certainly possible – education and help from others are crucial. Young people need help to understand the benefits of quitting nicotine, such as better health, saving money, saving time and freedom from addiction and withdrawal. Motivational interviewing and good cooperation with the young user is an effective method, emphasising their independence, freedom and responsibility for their own life. All SÁÁ staff are trained in this technique, and teachers and everyone who works with young people could also use it.

Link to the video:

https://vimeo.com/790823618

Ideas for discussions and/or projects for young people:

• Good support from others is one of the best ways to stop addictive behaviour. Could the school system help students in this way? How, in particular?
• The “positive” effects of nicotine are only felt right at the beginning; after that, use is only to stop withdrawal symptoms. Is it worth starting? How could you give your body pleasure other than by making it dependent on a toxic substance?

Viðar Guðjohnsen, inspector at the market surveillance department of the Icelandic Medicines Agency

Viðar discusses the classification of nicotine products, saying that for a long time they were classified either as tobacco products or as medicines (for treating tobacco addiction), and thus fell under different areas of law. Today, one of the roles of the Icelandic Medicines Agency is to assess “borderline products” that are not manufactured as medicines but may fall within the scope of the Medicines Act, such as nicotine, vitamins and minerals. Viðar says nicotine is a highly toxic, very addictive substance with various harmful effects (and is indeed derived from the tobacco plant), but tobacco-free nicotine products are not classified as tobacco, nor as medicines, as they are rarely used to overcome tobacco addiction. New users of nicotine products are not smokers but young people who have never smoked, and use among young people (especially girls) is increasing. This classification problem means that production is generally not certified by public bodies and no health professionals are involved in development, so the pouches have been little studied and can contain dangerously high concentrations of nicotine.

Link to the talk:

https://vimeo.com/790824099

Ideas for discussions and/or projects for young people:
We still know very little about the long-term effects of nicotine pouches, but we do know that the substance is highly toxic. Is it worth being a guinea pig and hoping for the best?

• Why do you think tobacco-free nicotine products went into production just when society knew so much about the harmful effects of tobacco and smoking was in sharp decline?

Árni Einarsson, managing director of Fræðsla og forvarnir

Árni presents the long and successful history of tobacco control in Iceland. In the 1970s it became generally accepted that tobacco use had various negative effects on health, and a national campaign to eliminate smoking began. Legislation on supply and sale followed, along with strong education in young people’s environment. This focused effort led to a sharp drop in tobacco use among 12–16-year-olds, as well as in adult smoking. Árni says society is now facing a repeat and asks whether we need to stay alert, guided by public health and the national good. This is the clear will of the nation, as annual Gallup surveys show strong support for banning e-cigarettes in restaurants and bars, and for making the purchase of nicotine pouches subject to the same conditions as the purchase of other nicotine products. The majority of Icelanders also believe that using e-cigarettes and nicotine pouches is about as harmful as smoking tobacco.

Link to the talk:
https://vimeo.com/790815194

Ideas for discussions and/or projects for young people:

• Once, people could smoke cigarettes on planes, in hospitals and in schools. We knew nothing about the harmful effects of tobacco until numerous studies (and deaths) confirmed the risk. The production, marketing and use of nicotine products follow the same patterns as when cigarettes first came on the market. Is it likely or unlikely that nicotine pouches will follow the same pattern as tobacco and eventually be banned and little used?
• Why do you think younger people are more positive towards nicotine products than older people (according to Gallup surveys)? Is Árni right that older people remember how bad it was to be dependent on a harmful substance and how hard it was to quit smoking, and want to spare young people today such an experience?

Kristín Ninja Guðmundsdóttir, lawyer at the Health Inspectorate

Kristín goes through the newly adopted act on nicotine products; until June 2022 there were no rules on such products. Given the spread and nature of nicotine pouches, legislation quickly became urgent. Placing the pouches under laws on, for example, tobacco, medicines, food or e-cigarettes was considered, but no existing legislation was found to apply, so an addictive product flowed into the country without supervision or regulation of, for example, marketing, ingredients or age limits. There was therefore an urgent need for new legislation, but there is still no harmonised European legislation on nicotine pouches. Kristín says other countries’ legislation varies: the pouches are classified differently and laws go to different lengths. The Icelandic bill emphasises deterrence and warning effects, supervision and penalties, with the aim of reducing use and preventing new users among young people. Kristín goes through the main provisions of the new act, such as those on sale and marketing, labelling and packaging design, maximum nicotine content and additional ingredients, age limits and regular education, and finally penalties for breaches.

Link to the talk:
https://vimeo.com/790816476

Ideas for discussions and/or projects for young people:

• Some people want as few restrictions as possible on the sale and production of nicotine pouches, arguing that the product reduces harm and helps people quit tobacco. How does that fit with the fact that most users of the pouches are young people who have never used tobacco?

Andrea Ýr Jónsdóttir, nurse at Heilsulausnir

Andrea presents her company Heilsulausnir, which does prevention work and educates young people all over the country. She says nicotine pouches have been greatly normalised by society, young people’s environment and even their role models. Access to the pouches is wide open, whether through legal sales or on the black market. Andrea says Heilsulausnir’s youth education is based on motivational interviewing and active discussion. The nurses focus on self-image and ways to build it, as a strong self-image is the best prevention against all risk behaviour. They prefer constructive messages and useful information over rules and bans – talking with young people rather than at them, so that they can make informed decisions about their own lives. Follow-up is just as important as the education session itself, so Heilsulausnir also offers parent education and material for schools to use. Andrea says young people generally know little about nicotine, think it is fairly harmless and do not know how addictive it is. However, most are aware of and opposed to smoking, which shows the good results of tobacco prevention work. Education and discussion about nicotine products is therefore the right way forward today.

Link to the talk:

https://vimeo.com/790813830

Ideas for discussions and/or projects for young people:

• Why do you think most teenagers know how harmful cigarettes are but know little about the harmful effects of nicotine pouches? Would more education about nicotine reduce use among young people, as tobacco education did decades ago?
• Used nicotine pouches are extremely dangerous to young children (and animals), but people spit them out anywhere. How would it feel to throw away a pouch... that a small child then puts in their mouth and becomes critically ill from nicotine poisoning?