Association of tobacco and other substance use with nicotine pouch awareness and use in US adolescents.

Abstract

Evidence on the association between tobacco/nicotine and other substance use (TOSU) and adolescent nicotine pouch (NP) awareness and use is lacking but vital for policy and prevention planning. The sample was drawn from the 2023 Monitoring the Future study, a nationally representative survey of U.S. adolescents (8th, 10th, 12th graders). One-third of participants were randomly selected to complete questions on NP awareness and use (lifetime, past 12-month, past 12-month frequency) and past 30-day TOSU measures (yes/no). We estimated risk ratios (RRs) and incident rate ratios (IRRs) to examine the associations between TOSU and NP awareness and use. Overall (n = 6958; 53.4 % female), 35.4 % reported NP awareness, 2.5 % reported lifetime use, and 1.8 % reported past 12-month use. Past 30-day use of tobacco/nicotine products was each positively associated with NP awareness (RRs:1.42-1.70), lifetime (RRs:7.14-20.40), and past 12-month (RRs:5.84-22.44) use, with the strong associations for youth with vs. without smokeless tobacco use. Cannabis, alcohol, and other drug past 30-day use were each associated with NP awareness (RRs:1.49-1.68), lifetime (RRs:3.47-10.49), and past 12-month (RRs:4.70-15.70) use. NP awareness and use prevalence were disproportionately high among adolescents with various forms of TOSU in 2023, especially smokeless tobacco. These findings suggest the importance of monitoring NP use among youth with TOSU while recognizing that awareness may also reflect broader marketing, product availability, or incidental exposure. Policy and prevention efforts should address NP use alongside TOSU with established health risks.