Abstract
This cross-sectional study describes nicotine pouch use among adolescents and adults who use other nicotine products.
Introduction
The tobacco marketplace is shifting such that noncombustible (ie, less harmful) products are displacing more harmful combustible products. One product gaining traction is tobacco-free oral nicotine pouches, which are small, permeable pouches containing a synthetically-produced, crystalized nicotine salt powder (and stabilizers, fillers, pH adjusters, and sweeteners).1 Market analyses show exponential growth in the sales of these products, which is projected to continue to increase, possibly due to rapid delivery of high nicotine concentrations, increased marketing, and appealing flavors.2 This study provides an estimate of nicotine pouch use prevalence, inclusive of other tobacco use history, among youths and adults in the US.
Methods
This cross-sectional study was exempt from review per 45 CFR §46.104. All participants provided informed consent.3 This study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Data for this study were collected as a part of the Population Assessment of Tobacco and Health (PATH)4 wave 7 (January 2022 to April 2023) youths (age 12-17 years; response rate, 54.3%) and adult (age ≥18 years; response rate, 52.4%) cohorts, a nationally representative, publicly available longitudinal US survey approved by the Westat institutional review board. Race and ethnicity were self-reported; further details are provided in the eMethods in Supplement 1.
Analyses present pouch use outcomes by demographics and other relevant tobacco use characteristics (eg, smoking history). Pouch outcomes of interest include ever use, past 12 months use, and past 30 days use. Balanced repeated replication weighting procedures were used for frequency analyses, completed on SAS software version 9.4 (SAS Institute) from January to March 2025. Logistic regression models estimated the association of sociodemographic variables on outcomes, adjusted for all other demographics, and tobacco use variables on outcomes, adjusted for demographics, with a 2-sided Bonferroni corrected α = .0167.
Results
The analytic sample included 10 632 adolescents (51.25% [95% CI, 51.18%-51.33%] male; 25.82% [95% CI, 25.68%-25.95%] Hispanic; 65.25% [95% CI, 64.71%-65.80%] White) and 29 754 adults (48.48% [95%CI, 48.44%-48.51%] male; 17.14% [95% CI, 17.08%-17.21%] Hispanic; 74.40% [95%CI, 74.07%-74.74%] White) (eMethods in Supplement 1). As shown in Table 1 and Table 2, 0.85% (95% CI, 0.69%-1.01%) of adolescents and 3.34% (95% CI, 3.04%-3.64%) of adults reported ever using oral nicotine pouches, 0.60% (95% CI, 0.47%-0.73%) of adolescents and 1.58% (95% CI, 1.39%-1.77%) of adults reported past-year use, and 0.21% (95% CI, 0.13%-0.30%) of adolescents and 0.82% (95% CI, 0.69%-0.96%) of adults reported use in the past 30 days. Older adolescents had higher odds of pouch use at each time point (ever, past 12 months, and past 30 days) relative to their younger counterparts, whereas younger adult age groups had higher odds of pouch use relative to those older than 65 years. In both cohorts, odds of pouch use were higher at each time point for males than females. Within both cohorts, individuals with current or former cigarette, e-cigarette, or smokeless tobacco use history had higher odds of pouch use at each time point relative to those without a tobacco use history. Finally, odds of pouch use were higher at each time point among individuals who had used other oral tobacco or cannabis in the past year compared with those who had not.
Table 1. Nicotine Pouch Use Among US Adolescents.
| Characteristic | Ever | Past 12 mo | Past 30 d | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. (%)a | Weighted, % (95% CI)b | aOR (95% CI)c | P valued | No. (%)a | Weighted, % (95% CI)b | aOR (95% CI)c | P valued | No. (%)a | Weighted, % (95% CI)b | aOR (95% CI)c | P valued | |||
| Overall (n = 10 632), No. | 105 | 0.85 (0.69-1.01) | NA | NA | 75 | 0.60 (0.47-0.73) | NA | NA | 29 | 0.21 (0.13-0.30) | NA | NA | ||
| Sex | ||||||||||||||
| Male | 77 (73.33) | 1.20 (0.95-1.46) | 2.65 (1.69-4.17) | <.001 | 58 (77.33) | 0.90 (0.67-1.14) | 3.46 (1.95-6.15) | <.001 | 27 (93.10) | 0.39 (0.24-0.55) | 24.36 (3.30-179.72) | .002 | ||
| Female | 27 (25.71) | 0.47 (0.29-0.66) | 1 [Reference] | NA | 16 (21.33) | 0.27 (0.13-0.42) | 1 [Reference] | NA | 2 (6.90) | 0.02 (0.00-0.06) | 1 [Reference] | NA | ||
| Age, y | ||||||||||||||
| 12-14 | 21 (20.00) | 0.39 (0.21-0.57) | 1 [Reference] | NA | 10 (13.33) | 0.19 (0.08-0.31) | 1 [Reference] | NA | 4 (13.79) | 0.07 (0.00-0.14) | 1 [Reference] | NA | ||
| 15-17 | 84 (80.00) | 1.33 (1.03-1.63) | 3.35 (2.05-5.49) | <.001 | 65 (86.67) | 1.02 (0.75-1.30) | 5.08 (2.59-9.94) | <.001 | 25 (86.21) | 0.36 (0.20-0.52) | 4.85 (1.67-14.05) | .004 | ||
| Race | ||||||||||||||
| Black | 1 (<1) | 0.02 (0.00-0.06) | 0.05 (0.01-0.38) | .004 | 1 (1.33) | 0.02 (0.00-0.06) | 0.08 (0.01-0.57) | .0118 | 1 (3.45) | 0.02 (0.00-0.06) | 0.24 (0.03-1.83) | .17 | ||
| White | 90 (85.71) | 1.20 (0.95-1.44) | 1 [Reference] | NA | 65 (86.67) | 0.86 (0.65-1.06) | 1 [Reference] | NA | 25 (86.21) | 0.31 (0.18-0.44) | 1 [Reference] | NA | ||
| Othere | 14 (13.33) | 0.56 (0.31-0.82) | 0.68 (0.38-1.22) | .20 | 9 (12.00) | 0.36 (0.15-0.56) | 0.60 (0.29-1.26) | .18 | 3 (10.34) | 0.11 (0.00-0.25) | 0.64 (0.19-2.13) | .46 | ||
| Ethnicity | ||||||||||||||
| Hispanic | 10 (9.52) | 0.32 (0.10-0.54) | 3.72 (1.84-7.53) | <.001 | 6 (8.00) | 0.18 (0.03-0.33) | 4.35 (1.72-11.04) | .002 | 1 (3.45) | 0.01 (0.00-0.04) | 8.09 (1.07-60.93) | .04 | ||
| Non-Hispanic | 92 (87.62) | 1.04 (0.83-1.25) | 1 [Reference] | NA | 67 (89.33) | 0.75 (0.59-0.92) | 1 [Reference] | NA | 27 (93.10) | 0.2 (0.17-0.40) | 1 [Reference] | NA | ||
| Income, $ | ||||||||||||||
| <50 000 | 24 (22.86) | 0.61 (0.36-0.86) | 0.98 (0.61-1.58) | .94 | 13 (17.33) | 0.33 (0.13-0.53) | 0.72 (0.38-1.33) | .29 | 4 (13.79) | 0.07 (0.00-0.15) | 0.56 (0.19-1.65) | .29 | ||
| ≥50 000 | 79 (75.24) | 1.02 (0.77-1.27) | 1 [Reference] | NA | 60 (90.00) | 0.77 (0.55-0.99) | 1 [Reference] | NA | 24 (82.76) | 0.29 (0.16-0.42) | 1 [Reference] | NA | ||
| Cigarette usef | ||||||||||||||
| Current | 19 (18.10) | 14.17 (8.38-19.98) | 38.82 (20.45-73.68) | <.001 | 14 (18.67) | 10.60 (5.26-15.94) | 33.59 (16.06-70.22) | <.001 | 9 (31.03) | 5.14 (1.06-9.22) | 59.82 (21.53-166.17) | <.001 | ||
| Former | 49 (46.67) | 7.39 (5.47-9.31) | 17.74 (11.13-28.30) | <.001 | 33 (44.00) | 4.93 (3.29-6.56) | 14.78 (8.54-25.59) | <.001 | 11 (37.93) | 1.45 (0.72-2.19) | 13.31 (5.12-34.56) | <.001 | ||
| Never | 37 (35.24) | 0.33 (0.21-0.45) | 1 [Reference] | NA | 28 (37.33) | 0.24 (0.14-0.34) | 1 [Reference] | NA | 9 (31.03) | 0.07 (0.03-0.15) | 1 [Reference] | NA | ||
| E-cigarette useg | ||||||||||||||
| Current | 55 (52.38) | 8.27 (5.60-10.65 | 57.87 (29.91-111.95) | <.001 | 41 (54.67) | 6.09 (4.24-7.95) | 48.48 (22.94-102.46) | <.001 | 24 (82.76) | 3.24 (1.83-4.66) | 99.46 (27.89-354.71) | <.001 | ||
| Former | 36 (34.29) | 3.17 (2.17-4.18) | 20.10 (10.34-39.10) | <.001 | 23 (30.67) | 2.06 (1.24-2.88) | 14.86 (6.88-32.10) | <.001 | 2 (6.90) | 0.15 (0.00-0.37) | 5.43 (0.84-34.99) | .08 | ||
| Never | 14 (13.33) | 0.14 (0.05-0.22) | 1 [Reference] | NA | 11 (14.67) | 0.10 (0.03-0.17) | 1 [Reference] | NA | 3 (10.34) | 0.03 (0.00-0.06) | 1 [Reference] | NA | ||
| Smokeless tobacco useh | ||||||||||||||
| Current | 10 (9.52) | 50.12 (28.09-72.11) | 72.37 (25.96-201.73) | <.001 | 10 (13.33) | 50.10 (28.09-72.12) | 89.61 (31.06-258.59) | <.001 | 7 (24.14) | 34.23 (13.03-55.42) | 148.03 (45.47-481.98) | <.001 | ||
| Former | 33 (31.43) | 20.59 (14.26-26.91) | 34.60 (20.92-57.22) | <.001 | 21 (28.00) | 12.89 (7.34-18.43) | 27.59 (15.15-50.22) | <.001 | 8 (27.59) | 4.13 (0.94-7.31) | 24.75 (9.24-66.29) | <.001 | ||
| Never | 62 (59.05) | 0.53 (0.39-0.67) | 1 [Reference] | NA | 44 (58.67) | 0.37 (0.26-0.48) | 1 [Reference] | NA | 14 (48.28) | 0.11 (0.05-0.18) | 1 [Reference] | NA | ||
| Other oral product usei | ||||||||||||||
| Past 12 mo | 15 (14.29) | 27.82 (12.98-42.66) | 56.26 (25.19-125.65) | <.001 | 15 (20.00) | 27.82 (12.98-42.66) | 96.11 (40.54-227.82) | <.001 | 5 (17.24) | 8.06 (0.00-16.32) | 51.10 (14.63-178.53) | <.001 | ||
| None | 89 (84.76) | 0.72 (0.56-0.87) | 1 [Reference] | NA | 60 (80.00) | 0.47 (0.36-0.60) | 1 [Reference] | NA | 24 (82.76) | 0.18 (0.10-0.26) | 1 [Reference] | NA | ||
| Cannabis use | ||||||||||||||
| Past 12 mo | 39 (37.14) | 3.38 (1.90-4.86) | 6.87 (3.872-12.19) | <.001 | 15 (20.00) | 2.09 (1.02-3.17) | 6.68 (3.30-13.54) | <.001 | 5 (17.24) | 0.64 (0.00-1.28) | 6.09 (1.778-0.86) | .004 | ||
| None | 22 (20.95) | 0.45 (0.28-0.62) | 1 [Reference] | NA | 25 (33.33) | 0.29 (0.15-0.43) | 1 [Reference] | NA | 9 (31.03) | 0.10 (0.03-0.17) | 1 [Reference] | NA | ||
Abbreviations: aOR, adjusted odds ratio; NA, not applicable.
Unweighted number and column percentages. Numbers may not add up to full sample due to missing data. Models with cell sizes less than 10 should be interpreted with caution due to unreliable estimates.
Row percentage of participants responding affirmatively compared with those responding No.
Models with demographic exposure variables (sex, age, race, ethnicity, income, and education) are adjusted for the other sociodemographic variables, and each model of tobacco or cannabis use exposure variables is adjusted for all sociodemographic variables.
Significance was determined after Bonferroni adjustment for the 3 reported outcomes (ever use, past 12-month use, past 30-day use) at a threshold P < .0167.
The other category included Asian and other races, including multiracial.
Current smoking is defined as smoking a cigarette within the past 30 days; former smoking, having ever smoked a cigarette but not within the past 30 days; and never smoking, having never smoked a cigarette.
Current vaping is defined as using an e-cigarette within the past 30 days; former vaping, having ever used an e-cigarette but not within the past 30 days; and never vaping, having never used an e-cigarette.
Smokeless tobacco is inclusive of dip, chewing tobacco, smokeless tobacco pouches, moist snuff, and snus. Current smokeless use is defined as using smokeless tobacco within the past 30 days; former smokeless, having ever used smokeless but not within the past 30 days; and never smokeless, having never used smokeless tobacco.
Other oral tobacco products include nontherapeutic gum or lozenges, toothpicks, discs, dissolvables, and tablets.
Table 2. Nicotine Pouch Use Among US Adults.
| Characteristic | Ever | Past 12 mo | Past 30 d | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. (%)a | Weighted, % (95% CI)b | aOR (95% CI)c | P valued | No. (%)a | Weighted, % (95% CI)b | aOR (95% CI)c | P valued | No. (%)a | Weighted, % (95% CI)b | aOR (95% CI)c | P valued | |
| Overall (n = 29 754), No. | 1408 | 3.34 (3.04-3.64) | NA | NA | 763 | 1.58 (1.39-1.77) | NA | NA | 375 | 0.82 (0.69-0.96) | NA | NA |
| Sex | ||||||||||||
| Male | 1032 (73.30) | 5.40 (4.92-5.89) | 3.20 (2.82-3.64) | <.001 | 586 (76.80) | 2.60 (2.29-2.92) | 3.81 (3.19-4.56) | <.001 | 306 (81.60) | 1.39 (1.18-1.60) | 5.03 (3.83-6.604 | <.001 |
| Female | 376 (26.70) | 1.40 (1.22-1.60) | 1 [Reference] | NA | 177 (23.20) | 0.63 (0.50-0.76) | 1 [Reference] | NA | 69 (18.40) | 0.29 (0.19-0.40) | 1 [Reference] | NA |
| Age, y | ||||||||||||
| 18-24 | 505 (35.87) | 5.57 (5.01-6.13) | 4.87 (3.51-6.76) | <.001 | 343 (44.95) | 3.76 (3.30-4.23) | 21.69 (10.16-46.30) | <.001 | 141 (37.60) | 1.55 (1.26-1.84) | 22.71 (7.13-72.28) | <.001 |
| 25-34 | 431 (30.61) | 5.52 (4.68-6.36) | 5.49 (3.98-7.58) | <.001 | 235 (30.80) | 3.05 (2.48-3.63) | 18.18 (8.53-38.76) | <.001 | 122 (32.53) | 1.64 (1.27-2.02) | 21.81 (6.91-68.88) | <.001 |
| 35-44 | 187 (13.28) | 3.82 (3.02-4.63) | 4.16 (2.95-5.87) | <.001 | 87 (11.40) | 1.79 (1.28-2.31) | 11.50 (5.27-25.08) | <.001 | 53 (14.13) | 1.07 (0.72-1.41) | 16.40 (5.07-53.03) | <.001 |
| 45-54 | 132 (9.38) | 3.34 (2.61-4.09) | 3.50 (2.45-5.02) | <.001 | 59 (7.73) | 1.19 (.88-1.51) | 10.15 (4.59-22.42) | <.001 | 37 (9.87) | 0.69 (0.46-0.92) | 15.15 (4.63-49.56) | <.001 |
| 55-64 | 103 (7.32) | 2.03 (1.57-2.51) | 2.27 (1.57-3.29) | <.001 | 32 (4.19) | 0.61 (0.36-0.86) | 4.30 (1.86-9.91) | <.001 | 19 (5.07) | 0.35 (0.14-0.57) | 5.58 (1.61-19.31) | .0066 |
| ≥65 | 50 (3.55) | 1.01 (0.60-1.43) | 1 [Reference] | NA | 7 (<1) | 0.10 (0.01-0.20) | 1 [Reference] | NA | 3 (<1) | 0.05 (0.00-0.10) | 1 [Reference] | NA |
| Race | ||||||||||||
| Black | 84 (5.97) | 1.38 (1.01-1.75) | 0.21 (0.17-0.27) | <.001 | 34 (4.46) | 0.51 (0.31-0.72) | 0.17 (0.12-0.25) | <.001 | 18 (4.80) | 0.29 (0.12-0.46) | 0.22 (0.13-0.35) | <.001 |
| White | 1156 (82.10) | 3.88 (3.48-4.28) | 1 [Reference] | NA | 635 (83.22) | 1.86 (1.60-2.12) | 1 [Reference] | NA | 314 (83.73) | 0.97 (0.79-1.15) | 1 [Reference] | NA |
| Othere | 150 (10.65) | 2.65 (2.06-3.25) | 0.64 (0.53-0.77) | <.001 | 78 (10.22) | 1.19 (0.86-1.52) | 0.56 (0.44-0.72) | <.001 | 35 (9.33) | 0.57 (0.34-0.80) | 0.54 (0.37-0.78) | .001 |
| Ethnicity | ||||||||||||
| Hispanic | 155 (11.01) | 1.48 (1.09-1.87) | 1 [Reference] | NA | 82 (10.75) | 0.68 (0.44-0.92) | 1 [Reference] | NA | 37 (9.87) | 0.40 (0.20-0.60) | 1 [Reference] | NA |
| Non-Hispanic | 1231 (87.43) | 3.74 (3.40-4.08) | 2.90 (2.41-3.49) | <.001 | 671 (87.94) | 1.79 (1.56-2.01) | 3.21 (2.47-4.15) | <.001 | 333 (88.80) | 0.92 (0.77-1.07) | 3.13 (2.15-4.57) | <.001 |
| Income, $ | ||||||||||||
| <50 000 | 595 (42.26) | 3.13 (2.76-3.48) | 1.01 (0.89-1.14) | .89 | 308 (40.37) | 1.42 (1.18-1.67) | 1.02 (0.87-1.21) | .79 | 144 (38.40) | 0.71 (0.55-0.86) | 1.01 (0.80-1.27) | .95 |
| ≥50 000 | 751 (53.34) | 3.62 (3.17-4.07) | 1 [Reference] | NA | 424 (55.57) | 1.79 (1.52-2.06) | 1 [Reference] | NA | 222 (59.20) | 0.98 (0.79-1.16) | 1 [Reference] | NA |
| Education | ||||||||||||
| Less than HS | 114 (8.10) | 2.93 (2.30-3.56) | 1.00 (0.76-1.32) | .98 | 44 (5.77) | 0.99 (0.62-1.38) | 0.64 (0.43-0.95) | .03 | 19 (5.07 | 0.46 (0.23-0.69) | 0.48 (0.27-0.85) | .01 |
| HS or GED | 398 (28.27) | 3.64 (3.13-4.15) | 1.24 (1.03-1.48) | .02 | 207 (27.13) | 1.60 (1.30-1.91) | 0.91 (0.72-1.16) | .44 | 95 (25.33) | 0.80 (0.55-1.05) | 0.76 (0.55-1.06) | .10 |
| Some college | 545 (38.71) | 4.20 (3.62-4.77) | 1.31 (1.12-1.52) | <.001 | 304 (39.84) | 2.02 (1.67-2.37) | 1.11 (0.91-1.35) | .32 | 142 (37.87) | 1.02 (0.77-1.28) | 0.97 (0.74-1.28) | .84 |
| College graduate | 348 (24.72) | 2.43 (2.04-2.82) | 1 [Reference] | NA | 207 (27.13) | 1.34 (1.07-1.60) | 1 [Reference] | NA | 118 (31.47) | 0.76 (0.58-0.94) | 1 [Reference] | NA |
| Cigarette smoking historyf | ||||||||||||
| Current | 428 (30.40) | 8.00 (6.97-9.05) | 5.47 (4.56-6.55) | <.001 | 202 (26.47) | 3.42 (2.78-4.07) | 4.78 (3.78-6.06) | <.001 | 88 (23.47) | 1.45 (1.04-1.85) | 3.18 (2.27-4.46) | <.001 |
| Former | 442 (31.39) | 5.29 (4.65-5.93) | 4.21 (3.56-4.97) | <.001 | 212 (27.79) | 2.27 (1.82-2.71) | 3.69 (2.97-4.58) | <.001 | 121 (32.27) | 1.29 (0.94-1.64) | 3.24 (2.43-4.31) | <.001 |
| Never | 538 (38.21) | 1.57 (1.34-1.80) | 1 [Reference] | NA | 349 (45.74) | 0.92 (0.76-1.08) | 1 [Reference] | NA | 166 (44.27) | 0.51 (0.39-0.62) | 1 [Reference] | NA |
| E-cigarette use historyg | ||||||||||||
| Current | 534 (37.93) | 17.34 (15.52-19.17) | 7.53 (6.52-8.71) | <.001 | 327 (42.86) | 9.99 (8.42-11.57) | 8.23 (6.80-9.96) | <.001 | 136 (36.27) | 4.18 (3.23-5.14) | 5.95 (4.55-7.77) | <.001 |
| Former | 336 (23.86) | 9.69 (8.27-11.11) | 3.79 (3.25-4.42) | <.001 | 187 (24.51) | 5.21 (4.20-6.22) | 4.54 (3.69-5.59) | <.001 | 101 (26.93) | 2.96 (2.21-3.71) | 4.13 (3.13-5.45) | <.001 |
| Never | 538 (38.21) | 1.85 (1.61-2.09) | 1 [Reference] | NA | 249 (32.63) | 0.70 (0.57-0.84) | 1 [Reference] | NA | 138 (36.80) | 0.41 (0.32-0.51) | 1 [Reference] | NA |
| Smokeless tobacco useh | ||||||||||||
| Current | 140 (9.94) | 25.82 (20.72-30.92) | 10.50 (8.24-13.39) | <.001 | 111 (14.55) | 20.36 (15.56-25.16) | 18.85 (14.14-25.13) | <.001 | 64 (17.07) | 11.81 (8.29-15.32) | 16.61 (11.63-23.73) | <.001 |
| Former | 435 (30.89) | 20.55 (17.94-23.17) | 7.57 (6.50-8.82) | <.001 | 221 (28.96) | 8.90 (7.56-10.25) | 7.35 (5.97-9.04) | <.001 | 117 (31.20) | 4.81 (3.69-5.94) | 6.95 (5.26-9.18) | <.001 |
| Never | 833 (59.16) | 1.86 (1.65-2.08) | 1 [Reference] | NA | 431 (56.49) | 0.80 (0.68-0.92) | 1 [Reference] | NA | 194 (51.73) | 0.38 (0.31-0.46) | 1 [Reference] | NA |
| Other oral product usei | ||||||||||||
| Past 12-mo | 166 (11.79) | 40.31 (34.85-45.76) | 12.71 (10.06-16.06) | <.001 | 138 (18.09) | 31.86 (26.11-37.61) | 21.00 (16.23-27.18) | <.001 | 65 (17.33) | 16.45 (11.28-21.62) | 12.75 (9.21-17.65) | <.001 |
| None | 1241 (88.14) | 2.95 (2.70-3.20) | 1 [Reference] | NA | 624 (81.78) | 1.26 (1.11-1.41) | 1 [Reference] | NA | 309 (82.41) | 0.65 (0.55-0.75) | 1 [Reference] | NA |
| Cannabis use | ||||||||||||
| Past 12 mo | 614 (43.61) | 2.24 (1.96-2.52) | 1.80 (1.57-2.07) | <.001 | 212 (27.79) | 2.85 (2.36-3.34) | 1.92 (1.59-2.32) | <.001 | 91 (24.27) | 1.25 (0.94-1.57) | 1.37 (1.05-1.78) | .02 |
| None | 383 (27.20) | 5.70 (4.93-6.47) | 1 [Reference] | NA | 308 (40.37) | 0.98 (0.81-1.16) | 1 [Reference] | NA | 180 (48.00) | 0.60 (0.47-0.73) | 1 [Reference] | NA |
Abbreviations: aOR, adjusted odds ratio; HS, high school; GED, General Equivalency Degree; NA, not applicable.
Unweighted number and column percentage. Numbers may not add up to full sample due to missing data. Models with cell sizes less than 10 should be interpreted with caution due to unreliable estimates.
Row percentage responding affirmatively compared to those responding No.
Models with demographic exposure variables (sex, age race, ethnicity, income, education) are adjusted for the other sociodemographic variables, and each model of tobacco/cannabis use exposure variables are adjusted for all sociodemographic variables.
Significance was determined after Bonferroni adjustment for the three reported outcomes (ever use, past 12-month use, past 30-day use) at a threshold P < .0167.
The other category included Asian and other races including multiracial.
Current smoking is defined as smoking cigarettes everyday or some days and more than 100 lifetime cigarettes; former smoking, having ever smoked more than 100 cigarettes but not within the past 12 months; and never smoking, having never regularly smoked less than 100 lifetime cigarettes.
Current vaping is defined as using an e-cigarette regularly or fairly regularly every day or some days; former vaping, having ever used an e-cigarette regularly or fairly regularly but not within the past 12 months; and never vaping, having never regularly used an e-cigarette.
Smokeless tobacco use is inclusive of dip, chewing tobacco, smokeless tobacco pouches, moist snuff, and snus. Current use is defined as using smokeless regularly or fairly regularly every day or some days; former smokeless, having ever used smokeless regularly or fairly regularly but not within the past 12 months; and never smokeless, having never regularly used smokeless tobacco.
Other oral tobacco products include nontherapeutic gum or lozenges, toothpicks, discs, dissolvables, and tablets.
Conclusions
This cross-sectional study found that in the US, oral nicotine pouch use was most prevalent among males, older adolescents and young adults, and individuals who use other nicotine and tobacco products and cannabis. We reported higher prevalence for adults (3.34%) ever using pouches than a 2024 analysis of the 2022 Tobacco Use Supplement to the Current Population Survey, which reported 2.9% ever use.5 The 2024 National Youth Tobacco Survey (NYTS) found that 2.4% of high school students endorsed pouch use in the past 30 days,6 which is higher than reported here. Importantly, the NYTS data are more recent, which may suggest increasing pouch use among adolescents. However, comparability between surveys is limited by differences in survey methods. Other limitations of this study include the inability to draw longitudinal conclusions (as this was the first PATH wave to measure pouch use), and some results should be interpreted with caution due to small cell sizes. Continued, rigorous surveillance of nicotine pouch use is critical, as is research to understand reasons for pouch use and health outcomes, as the tobacco marketplace evolves.1
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Data Sharing Statement
References
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Associated Data
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Supplementary Materials
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