Nicotine pouch awareness, use and perceptions among young adults from six metropolitan statistical areas in the United States

Exposure to nicotine pouch marketing and nicotine pouch experimentation among U.S. adults who use commercial tobacco

Objective

U.S. nicotine pouch (NP) sales have grown since 2016. Among U.S. adults who currently and formerly used commercial tobacco, we examined demographic associations with learning about NPs through varying marketing channels, and their associations with NP experimentation overall and stratified by race/ethnicity.

Methods

A nationally representative sample of U.S. adults who currently and formerly used commercial tobacco (n = 1,700) were surveyed online in January-February 2021. Participants reported their demographics and whether they learned about NPs through nine marketing channels. We used weighted multivariable logistic regressions to examine demographic associations of each channel, and each channel's association with NP ever-use.

Results

Overall, 45.2 % were aware of NPs, and 17.4 % ever used NPs. Highest reported NP awareness was through stores (16.6 %), internet/social media ads (9.2 %), friends/family's social media (8.2 %), direct mail/email (7.6 %), and print media ads (6.9 %). Younger, female, Black and Hispanic (vs. White) adults had lower odds of NP awareness through various marketing channels than their counterparts. Black adults (vs. White) had higher odds of NP awareness through news stories on TV/radio/online. Awareness through each channel was associated with higher odds of ever-using NPs, especially brand sponsored events, brand website/social media accounts, and direct mail/email (p's < 0.05). Results were generally consistent when stratified by race/ethnicity, but notable differences were also observed (race/ethnicity interaction p < 0.05).

Conclusions

NP marketing may promote NP experimentation among U.S. adults who use commercial tobacco. Future research should examine whether exposure to NP marketing leads to poly-tobacco use, which could increase the detrimental health effects of tobacco use.

The Potential Impact of Oral Nicotine Pouches on Public Health: A Scoping Review

INTRODUCTION

Oral nicotine pouches (ONPs) are a new class of nicotine products. This scoping review summarizes evidence on ONPs and explores their potential public health impact.

AIMS AND METHODS

We conducted a structured literature search for empirical studies across three electronic databases through January 10, 2024. Outcomes included ONP product characteristics, use patterns, beliefs and perceptions, toxicity, and marketing and sales.

RESULTS

Sixty-two studies were included, 17 were industry-funded. Most studies were from the United States. While large variations across studies were observed in ONP youth prevalence estimates, nationally representative U.S. studies find current use at 1.5% and lifetime use below 2.5% through 2023. Between 35% and 42% of U.S. adolescents and young adults have heard of ONPs, and 9-21% of tobacco-naïve youth were susceptible to trying them. U.S. adult-use estimates varied widely (0.8%-3% current; 3%-16% lifetime use) and were limited to populations with a history of tobacco use. The chemical composition of ONPs suggests fewer harmful/potentially harmful compounds at lower levels than cigarettes and smokeless tobacco (SLT), except formaldehyde. Industry-funded studies find substantially less cytotoxicity compared to cigarettes and suggest that higher nicotine-strength ONPs can deliver nicotine at levels comparable to or higher than SLT or cigarettes, although with slower nicotine release than cigarettes. Evidence on the cytotoxicity of ONPs relative to SLT is mixed.

CONCLUSIONS

ONPs appear to be less toxic than cigarettes and deliver comparable nicotine, presenting an alternative for combustible product users, although key data are mainly available from industry-funded studies. Data from independent research is critically needed. Industry marketing of ONPs may encourage initiation in youth and situational and dual use in adults.

IMPLICATIONS

The review provides an initial assessment of the potential role of ONPs in harm reduction and aims to determine unintended consequences of their use (youth uptake and dual-use) and identify populations that disproportionately use the product. This information is essential for tobacco regulatory bodies in determining the net public health impact of nicotine pouches.

Dual and poly-nicotine and tobacco use among adolescents in the United States from 2011 to 2022

BACKGROUND

Adolescent nicotine and tobacco product use remains common despite declining smoking rates in the United States, likely due to the emergence of novel products. Concurrent use of multiple products may increase the risk of nicotine dependency and subsequent substance use.

AIM

To identify patterns and trends of dual and poly nicotine and tobacco use among adolescents in the US and explore associations of dual and poly nicotine and tobacco use with sociodemographic factors.

METHODS

12 years of annual National Youth Tobacco Survey data (2011-2022) from 242,637 respondents were used to examine prevalence trends of different combinations of nicotine or tobacco product use among adolescents in the US using weighted point estimates for each year. Poisson regression models examined sociodemographic factors associated with different patterns of dual and poly-product use from 2011 to 2022.

RESULTS

Overall, the prevalence of dual (i.e. at least two products) and poly (i.e. at least three products) use decreased between 2011 and 2021 (from 9.5 % to 2.8 % and from 5.1 % to 1.1 %, respectively), but showed signs of increase between 2021 and 2022 (3.7 % for dual and 1.7 % for poly use). The most common combinations included a combustible product with either a novel or noncombustible product. The risk for dual and poly-product use was higher among non-Hispanic Whites, males, and high school students.

CONCLUSIONS

Previously declining trends in the prevalence of tobacco/nicotine dual and poly use may have been reversed. Close monitoring and targeted tobacco control policies are essential to tackle multiple product use among adolescents.