Nicotine pouch use may be a step toward reducing more dangerous forms of tobacco

As lawmakers and public health experts debate the safety of nicotine pouches, researchers from Rutgers Health found that for now, most adults that use these products also have a history of tobacco use and may be choosing these products as a possible step toward reducing or quitting more dangerous forms of nicotine delivery.

The findings – believed to be the first national estimates of daily nicotine pouch use in the U.S. – were published in JAMA Network Open.

Faced with declining cigarette sales, tobacco manufacturers in the U.S. are turning to tobacco-free nicotine pouches, such as Velo and Zyn, which are among the few segments of the industry that's growing.

In January 2025, the U.S. Food and Drug Administration authorized the marketing of ZYN, the first nicotine pouch to receive such authorization. Importantly, pouches cannot be marketed as smoking cessation aids – such as patches, gums and lozenges approved for therapeutic use – even if some people appear to be turning to them for that reason.

Against this backdrop, Cristine D. Delnevo, director of the Rutgers Institute for Nicotine and Tobacco Studies, set out to assess how widely nicotine pouches are being used among U.S. adults, and to establish a baseline for monitoring future changes in user habits.

By analyzing data from the U.S. Census Bureau's 2022-2023 Tobacco Use Supplement, which surveyed more than 110,000 adults across the country on their use of nicotine pouches and traditional tobacco products, the researchers painted a picture of nicotine pouch uptake in the U.S. They examined quitting behavior of other tobacco products before and after 2019, when the product became widely available nationally.

They found that overall, the percentage of adults using the product remains low – just 2.5% non-Hispanic white men were the most likely to have used the product. Use among tobacco-naïve adults – those who had never used tobacco products – was virtually non-existent.

Most compelling, Delnevo said, the highest prevalence of current and daily nicotine pouch use was among adults with a history of tobacco use who had recently quit, suggesting that nicotine pouches may have played a role in their cessation.

"Our results suggest that adults may be using nicotine pouches for harm reduction given that use is highest among those that have recently quit another tobacco product or e-cigarettes," said Delnevo, who is also a distinguished professor at the Rutgers School of Public Health.

But questions remain. Researchers continue to study the long-term health effects of oral nicotine pouches. While nicotine itself does not cause cancer, nicotine is highly addictive and its use can impact cardiovascular health, such as by increasing blood pressure, among other concerns.

Evidence also suggests that the popularity of pouches may be increasing among young people, albeit slowly. The Centers for Disease Control and Prevention's 2024 National Youth Tobacco Survey found that 1.8% of U.S. middle and high school students reported using nicotine pouches, up from 1.1% in 2022.

That trend has added urgency to warnings from Delnevo and her colleagues, who in a previous JAMA commentary, urged the FDA to ensure the oral nicotine marketplace did not proliferate as uncontrollably as e-cigarettes.

"We should always keep a watchful eye on youth tobacco-use behaviors, including use of multiple products, substitution with other products or alternative methods of finding and using flavored tobacco and nicotine products," she said.

Yet, when used by established tobacco users, pouches may offer a health benefit, she added.

"People who have never used tobacco products should not suddenly be using nicotine pouches," she said. "But for people who smoke or use other nicotine products and don't want to stop using nicotine, switching completely from the more harmful product and moving down the risk continuum with nicotine pouches is a likely good for public health."

Mary Hrywna, an associate professor in the Department of Health Behavior, Society and Policy at the Rutgers School of Public Health, and a study co-author, agreed.

As nicotine pouches gain increased attention in the U.S., many agree that we need to better understand who is using these products and how. This study offers a snapshot of use patterns that is informative and, at least for now, somewhat reassuring."

Mary Hrywna, Associate Professor, Department of Health Behavior, Society and Policy, Rutgers School of Public Health