Nicotine pouches gain rapid popularity among adult tobacco users

A national survey study conducted by the University of Cincinnati found that nicotine pouch use increased sharply in the United States between 2021 and 2024 among adult tobacco users.

Nicotine pouch usage among "ever users" - individuals who have used the product at least once - rose from 16.4% to 31.1%, while current nicotine pouch use increased from 3% to 10.2% during the study period.

The lead investigator for the study is Ashley Merianos, PhD, professor in the University of Cincinnati School of Human Services. The study used repeated cross-sectional analysis of 2021 and 2024 YouGov survey data. It included a nationally representative sample of adult tobacco users in the United States.

The study findings were published recently in the scholarly journal Addiction.

Nicotine pouches contain a powder made of nicotine, flavorings and other ingredients. A pouch is placed between the upper or lower lip and the gum. Saliva releases the nicotine, which is absorbed through the gums and lining of the mouth. 

In 2024, use was more common among men, adults ages 21 to 45 and people currently using tobacco products, especially smokeless tobacco users. Merianos says these patterns suggest that nicotine pouches may be used alongside other forms of tobacco for some users.

Researchers say continued monitoring is needed to track nicotine pouch use, understand how pouches fit into people's overall nicotine use and identify populations with the highest rates of use.

Other study investigators include Joshua Lambert, PhD, associate professor in the University of Cincinnati College of Nursing, and Dan Petrovitch, PhD, postdoctoral researcher at Texas Tech University. Investigators participating in the study at the National Institutes of Health include Kristen Hamilton-Moseley, PhD, Bambi Jewett, MSN, and Kelvin Choi, PhD.

Our data show that what was once considered a niche nicotine product is becoming a mainstream product among U.S. adult tobacco users. Nicotine pouches are often marketed as tobacco-free alternatives, but there are still important unanswered questions regarding their long-term health effects and addiction potential."

Ashley Merianos, PhD, Professor, University of Cincinnati School of Human Services

"Our main results showed that nicotine pouch use is increasing rapidly," adds Merianos.

Younger adults are driving much of this growth, with adults ages 21 to 45 significantly more likely to report both "ever use" and current nicotine pouch use compared with adults over 60, adds Merianos.

Current tobacco use, not surprisingly, was one of the strongest predictors of nicotine pouch use. This suggests that these products are primarily being adopted by people who are already using other tobacco products, whether cigarettes or e-cigarettes, says Merianos.

"Most interestingly, smokeless tobacco users were the most likely to use nicotine pouches, indicating overlap between traditional oral tobacco products and newer nicotine pouch products," says Merianos. "Dual- and poly-tobacco use remain important concerns, as our study showed that many nicotine pouch users also report using other tobacco products."

Across groups, men had a higher prevalence of "ever use" and current use of nicotine pouches. That trend was also the case with smokeless tobacco use in general, whether snus - a Swedish smokeless and spitless tobacco product - or snuff. 

Nicotine is a stimulant that can impact the developing brain, and the human brain isn't fully developed until age 25. This is especially relevant for tobacco users ages 21–24. The group that included this age range saw a strong increase in nicotine pouch use.
"We don't yet know the long-term health consequences, and we also don't know the long-term addiction potential," explains Merianos. "If a young adult who has never smoked or used smokeless tobacco starts using nicotine pouches, will they become addicted to nicotine? And will they then switch to other products? That's what we're trying to figure out in the long term."

Merianos says public health officials must continue surveillance of emerging nicotine products and how they fit into the broader tobacco marketplace.

"The tobacco industry is very strategic," says Merianos. "They are always going to have new marketing tactics and new products. Look at what happened with electronic cigarettes. Now there are these nicotine pouches, which are exploding on the market."

Healthcare providers and other professionals across the Midwest - and across the United States - are increasingly likely to encounter patients using nicotine pouches. "The question is: Are they prepared to discuss both the knowns and unknowns surrounding these emerging products?" asked Merianos.